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* 1. Please select a date from the following list.

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* 2. Contact Information:

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* 3. Contact Information:

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* 4. Contact Information:

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* 5. Contact Information:

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* 6. Question(s) for speaker

Questions? Contact Roger Curtis: Email Roger@IowaDistrictWest.org - Office 515.576.7666 or Cell 515.408.7563

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