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* 1. Name:

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* 2. Email:

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* 4. Which school/university/college are you currently attending?

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* 5. Are you an international student?

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* 6. Which town/city are you from?

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* 8. What areas of tech are you most interested in? [Choose as many as apply]

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* 9. Where did you hear about us?

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* 10. Choose one of the below:

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