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* 1. Your contact information.

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* 2. Recommend three colleagues for APSARD membership.

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* 3. Please provide contact information for your department chair or training director for APSARD newsletters.

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* 4. Why did you join APSARD?

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* 5. How did you hear about APSARD?

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* 6. Please provide ideas on how APSARD can best grow our membership.

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