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* 1. Will you be registering more than one individual from the same agency/company? If YES please complete this form for each employee.

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* 2. Attendee Name

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* 3. Employer/Affiliation (if Applicable)

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* 4. Position/Job Title (if Applicable)

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* 5. Attendee Email Address

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* 6. Please re-enter attendee email address

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* 7. If email address for receiving invoice is different than the attendee's email, please enter it here:

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* 8. Telephone Number

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* 9. Please enter your mailing address

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* 10. Please list any dietary restrictions we can accommodate

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* 11. Do we have your permission to publish this attendee's name and contact information to share with other attendees? This would be part of the event materials provided.

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