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* 1. What is your first name?

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* 2. What is your last name?

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* 3. Email address?

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* 4. What is your role in relationship to public education?

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* 5. In what state or U.S. territory do you live?

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* 6. If you belong to a local or statewide organization that would like to affiliate with the Network for Public Education, please list the organization's name, and contact information below.

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