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* 1. Name (First and Last)

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* 2. Affiliation (Company or Self)

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* 3. Phone Number:

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* 4. Email Address:

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* 5. Years of experience in the industry?

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* 6. Short Bio (Paragraph)

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* 7. Headshot/Photo

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 8. Subjects of Expertise

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* 9. Are you willing to travel to various plants/facilities to present?

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* 10. Additional comments:

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