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* 1. Organization name:

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* 2. Contact name:

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* 3. Contact e-mail

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* 4. Contact phone:

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* 5. Contact fax:

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* 6. Title of Meeting:

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* 7. Purpose of Meeting:

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* 8. Meeting duration:

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* 9. First choice:
Day of Meeting

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* 10. First Choice:
Time of Meeting

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* 11. Second choice:
Day of Meeting

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* 12. Second Choice:
Time of Meeting

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* 13. Number of Attendees Expected:

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* 14. Desired Room Set-Up:

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* 15. Will you be ordering food/beverages?

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* 16. Will you require any audiovisual equipment?

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* 17. If you answered "Yes" to Question 16, what type of audiovisual equipment will you need?

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* 18. Should this event be included in the Reform Conference Program Guide?

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* 19. If you want this meeting included in conference print materials, please include a description:

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* 20. Should this event be posted on hotel reader boards?

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* 21. On-site contact:

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* 22. On-site contact cell phone:

**PLEASE note that meeting space at the hotel is limited and all submitted sessions are subject to approval.
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