Rural Recruitment Summit Interest Form

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* 1. Please choose from the following.

I am interested in attending the PA Rural Recruitment Summit.

I am interested in this issue but cannot attend the summit. Please keep me informed.

I am not interested in the summit or the issue of rural recruitment.

Other (please specify)

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* 2. Your Name

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* 3. Your Organization

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* 4. Your Email Address

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* 5. Your Phone Number

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* 6. Why are you interested in the Pennsylvania Rural Recruitment Summit?