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L-TALC Membership Application - Interest Form
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* Required
Please enter your full name.
*
Your answer
Please enter your preferred name (if applicable).
Your answer
Please select your gender.
*
Female
Male
Prefer not to say
Other:
Please select your ethnicity. (Check all that apply)
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Hispanic/Latino
Caucasian
African American
American Indian or Alaska Native
Asian, Native Hawaiian, or Pacific Islander
Other:
Required
Please provide your preferred email address.
*
Your answer
Please provide your BANNER ID (Enter "N/A" if you do not have a BANNER ID)
*
Your answer
Are you interested in learning more about our informal learning clubs?
Yes
No
Clear selection
What kind of school are you currently attending?
High school
Community college
4-year university
I am not attending a school at this time
Other:
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