Thank you for your interest in attending the M2012 Advocates' Pre-Conference Workshop: Advocacy in a New Prevention Landscape. Please fill out the following registration form. [There is no fee to attend the workshop, but we request that all attendees register in advance.]

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1. Salutation/Prefix (for example, Mr., Ms., Dr.) (Required.)

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2. First name (Required.)

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3. Last name (Required.)

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4. Organization/Affiliation

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5. Position/Title

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6. Mailing Address (Required.)

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7. Telephone number (Required.)

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8. Email (Required.)

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9. Confirm email (Required.)

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