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* 1. What is your name?

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* 2. If applicable, what is the name of your organization? 

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* 3. Would you, or someone from your organization, like to attend the Kirkpatrick reception? 

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* 4. If yes, please provide names and email addresses for people who would like to attend. 

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* 5. If you have any other comments, please enter them here. 

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