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* 1. Student first name:

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* 2. Student last name:

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* 3. Street address:

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* 4. City:

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* 5. State:

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* 6. Zip code:

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* 7. Phone number (with area code):

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* 8. Gender:

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* 9. Student email address:

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* 10. School:

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* 11. Classification (as of Fall 2014):

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* 12. What is your future major/area of interest?

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* 13. Parent(s)/Guardian(s) names:

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* 14. Parent(s)/Guardian(s) work phone:

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* 15. Will your parent(s) or guardian(s) attend the conference with you?

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* 16. Do you plan on requesting overnight lodging at Murray State University? (If yes, please complete the Housing Form listed on the main conference page.)

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* 17. If the student or parent(s)/guardian(s) need special accommodations (I.e. handicapped accessible rooms or vegetarian meals) during the conference, please specify below.

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* 18. Will the student or the parent(s)/guardian(s) need transportation to the conference? (Transportation will be arranged on a limited basis.)

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