BWHxG Registration Form

Last Name

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First Name

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Email Address

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University/Institution Affiliation

ex. University of Maryland, National Archives

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Rank/Title

ex. Assistant Professor, Archivist, Graduate Student

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Street Address

ex. 1111 Ida B. Wells Drive

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City, State Zip Code

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Phone Number

ex. 5556678901

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Comments

ex. dietary restrictions, accessibility needs, child care needs, etc.

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