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* 1. Society Name

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* 2. Your Name

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* 3. Class Year

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* 4. Email address

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* 5. Phone Number

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* 6. Activities I am most interested in are (check all that apply):

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* 7. I would most like to hear about events through:

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* 8. I prefer events that occur:

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* 9. I would like to see the events include:

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