Name:

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* 1. Name:

Company:

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* 2. Company:

Email Address:

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* 3. Email Address:

What City/State would you like to start a user group in?

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* 4. What City/State would you like to start a user group in?

Approximate date for first meetup:

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* 5. Approximate date for first meetup:

How many would you be willing to host a year?

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* 6. How many would you be willing to host a year?

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