Please complete this form, and within 48 hours we will reply to you regarding your scholarship and registration instructions.

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* 1. What is your full name?

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* 2. Contact Information

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* 3. How do you anticipate attending RespectCon 2016 will benefit you personally/academically/professionally?
Please respond in 1-2 paragraphs (~500 words)

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* 4.

Next year (in 2017), we hope to share some of the words and wisdom submitted in the previous Question 3 as a way to promote the conference - using the words of actual attendees. Please indicate below if you are comfortable or not with us using your submission for conference promotional purposes. We will not use your submission without your consent.

PLEASE NOTE: This question has NO BEARING on whether you receive a scholarship; we will not consider your answer to this question when we review your submission.

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