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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. What is your email address?

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* 4. What is your phone number?

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* 5. Do you need translation for this event?

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* 6. Are you requesting an accomodation for this event? (If you are, someone from the Office for Civil Rights will contact you.)

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* 7. Do you need childcare for this event? (On-site childcare will be provided for those who request it.)

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