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* 1. Name

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* 2. School, Grade Level or Other Position

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* 3. Your Preferred Email Address

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* 4. Billing Mailing Address of  (School if applicable, Name, Street, City, State, Zip)

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* 5. How will you make your payment?

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* 6. Which of the following items should we include on your billing Invoice (check as many as apply)?

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* 7. What are you looking to gain from your participation in this course?

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