Sponsors: Institute for Public Health and the Institute for Practical Ethics

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* 1. Space is limited and on a first-come, first-served basis.  Please check to indicate your understanding that a confirmation reminder, or notice of any changes (if applicable), will be sent to the email address that you provide below.  Thank you.

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* 2. Preferred title:

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* 3. First Name:

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* 4. Last Name:

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* 5. Affiliation(s):  UC San Diego and/or Others (including School, Department, Division, etc.)

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* 6. How did you hear about this event? (Check all that apply.)

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* 7. Email address (Confirmation will be sent to this address.)

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* 8. Please re-enter Email address (Confirmation will be sent to this address.)

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* 9. Institute for Public Health (IPH) events occur roughly 10 times/year.  Pls. indicate whether you wish to receive emails regarding future events.   (Check all that apply.)  I wish to receive event announcements about:

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