HA DPG - 2023 Virtual Conference registration stipend funding

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* 1. Please add your info here:

First name:

Last name:

Email address:

Academy #:

# of years as a HA DPG member:

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* 2. Please check your Academy membership category.

Active

Student

Retired

International

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* 3. Please include a brief statement here on your goals or expected outcomes for attending HA DPG's virtual conference.