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A House Divided | Request for Hard Copies of Issue Advisory

1.Contact Information

Name

Organization

Title

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

2.Approximately how many NIF forums are you planning between January 2019 - November 2019?

3.On approximately what date(s) will you hold your forum(s)? [Not a final or binding answer, we just want to get a pre-estimate of when forums will be happening.]

4.Which local partners are you hoping to collaborate with?

5.What type of forums are you planning?

K-12 Classroom Forums

University Student Forums

Open Community Forums

Intergenerational Forums

Other (please specify)

Shipping Address / Next Steps

6.Shipping Address for 20 hard copies of A House Divided Issue Advisory(Required.)

Name

Organization

Address 1

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

7.We will ship 20 Issue Advisories (including the post-forum questionnaire) to the above address. If you require less or more Issue Advisories, please let us know the number requested.

Thank you!

Current Progress,

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