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* 1. Title

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* 2. First Name

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* 3. Surname

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* 4. Email

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* 5. Organisation

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* 6. What is your position at your organisation?

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* 7. Please describe your current and future contributions to GLASS, and why this Busy Week is important for you. i.e. Why should we fund you?

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* 8. Please give a short budget justification and request (up to $1500). i.e. Lay out your airfare and hotel costs.

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