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* 1. Your Contact Information

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* 2. Supervisor contact information (name, email, phone):

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* 3. Describe how attending the 2017 WICT Leadership Conference would be beneficial for your career or your current role – what are your goals for attending this conference? (150 Words or less).

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* 4. Describe the skills do you most need to develop during this stage in your career.

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* 5. Describe your participation in WICT.

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