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* 1. Name

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* 2. Email

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* 3. Phone

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* 4. City/State

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* 5. Current Company & Position

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* 6. Do you have a large network?

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* 7. Does your network include company or nonprofit leaders that could use technology consulting services and/or technology project financing?

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* 8. Do you have the time to focus on being a Scout for us?

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* 9. What is your LinkedIn profile?

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* 10. Are you free to enter into a Scout relationship with us without it conflicting with your current work?

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