Please answer questions 1-4 as you would like them to appear on your name tag (to be distributed at event).

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* 1. Title

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* 2. First Name:

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* 3. Last Name:

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* 4. Name of Company:

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* 5. Type of Industry:

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* 6. What is your e-mail:

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* 7. Additional Information: please give us some info about your company/organization

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* 8. Is your company interested in:

 
Mentoring an Intern
Supporting student project
Research Collaboration
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