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.)

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* 2. First name

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* 3. Last name

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* 4. Organization/Affiliation

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* 5. Position/Title

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* 6. Mailing Address

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* 7. Telephone number

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* 8. Email

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* 9. Confirm email

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