First name:

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* 1. First name:

Surname:

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* 2. Surname:

Preferred email address:

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* 3. Preferred email address:

Are you a currently enrolled student at the University of Melbourne?

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* 4. Are you a currently enrolled student at the University of Melbourne?

If no, what is your relationship to the University of Melbourne? (please select all that apply)

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* 8. If no, what is your relationship to the University of Melbourne? (please select all that apply)

How would you like to be involved?

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* 9. How would you like to be involved?

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