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* 1. Your name

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* 2. Your email address

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* 4. What is your department affiliation?

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* 5. Title of Poster

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* 6. Name of primary contributors to the work (specify faculty mentor if this is a trainee submission)

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* 7. Area of work

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* 8. Name of person or people who will be present from 11:00am – 1:30pm to answer questions next to your exhibit in the Imaging Elevated Exhibit Hall

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