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* 1. Please enter your name.

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* 2. Please enter your email address.

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* 3. Please enter your phone number.

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* 4. What is your Modere Meetup location address? 

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* 5. What is your Modere Meetup registration link?
For your Meetup to be posted to the Modere Events Page, you must provide a valid registration link at the time of registration. 

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* 6. What is the date and time of your Modere Meetup?

Date
Time

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* 7. Please upload a proof of attendance list. (This will be used to determine incentive eligibility.  These are DUE by October 7th to qualify for incentives.  Please email registration lists to moderemeetup@modere.com)

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File

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* 8. I acknowledge that any cost associated with hosting my Modere Meetup will be at my own expense.

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