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* 1. Name

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* 2. Company

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* 3. E-mail

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* 4. What is your age?

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* 5. What is your career stage?

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* 6. Approximately how many years have you worked in clean energy?

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* 7. Are you interested in a Women in Clean Energy (WICE) mentorship program?

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* 8. Any thoughts, questions, or concerns?

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