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* 1. Which topics below are of most interest to you?

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* 2. What topics or issues would you like to see covered at the forum in each of the cities we cover and why?

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* 3. Who would you like to recommend as a speaker/panelist for the forum? What would you like to hear them speak about?

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* 4. Would you be interested in contributing to the event in any of the following ways?

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* 5. Please fill in your contact information.

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