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* 1. Name

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* 2. E-mail Address

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* 4. Jurisdiction

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* 5. Please select any accommodations you require from the list below. If you require something that is not listed, please indicate your request by selecting “Other” and provide us with specific information about your request in the comments box. We may contact you for further information, if necessary.

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* 6. Please indicate your interpretation needs from the list below

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* 7. Please enter any other needs you have for this event. Every effort will be made to accommodate advance requests; requests not the day of the event cannot be guaranteed. Reasonable accommodations will be provided during meeting sessions. Referrals for assistance outside of the meeting can be made available. Please contact Jeanne Larson at jlarson@bwjp.org with any questions or for more assistance.

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