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Name: __________________________________________________________________________
Affiliation: _______________________________________________________________________
Position: _______________________________________________________________________
Mailing Address: _________________________________________________________________
__________________________________________________________________
Email Address: ___________________________________________________________________
______ I am enclosing $75 which reserves my place at the symposium.
Please mail this registration form and check to:
Attn: Elaine Dumas
CEC/TAG
4516 I Street, #1
Little Rock, AR 72205