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* 1. Last Name

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* 2. First Name

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* 3. Organization / Affiliation

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* 4. Email

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* 5. My CanROC Site

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* 6. I am attending:

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* 7. I am attending: 

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* 8. I am attending: 

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* 9. Role

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* 10. I am attending the evening reception on April 29

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* 11. I have special dietary requirements (please specify):

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