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Name
*
Your answer
City and State
Please list the city and state that you be in between Jan and April?
Your answer
Current Employer or University
*
Your answer
What high school did you attend?
*
Please list the name, city, and state of your high school.
Your answer
Areas of interest
For example: Physics, Chemistry, Building events, etc.
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Email address
*
Must be a college/university/work email address. Sorry, no gmail, hotmail, or yahoo emails please
Your answer
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