Dinner & Lecture

First Name to be Printed on Name Tag*

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Please include your first name and title, if applicable (e.g., Dr. John)

Last Name to be Printed on Name Tag*

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Please include your last name and suffix, if applicable (e.g., Doe II)

Please provide your email address*

We need a valid email.

If you are a student, please list what school you attend.

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Whether high school, college, or university