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* 1. Are you interested in any of the following positions?

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* 2. What type of activities would you like to see the Society do more of?

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* 3. What location would you prefer events to take place?

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* 4. How far are you willing to travel (in miles) to participate in Society events?

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* 5. Comments

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* 6. Society Name

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* 7. Full Name

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* 8. Class Year

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* 9. Email Address

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* 10. Phone Number

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* 11. Zip Code

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