Registration: Legislative Day 2016
Please use this form to register for attendance for Legislative Day 2016 sponsored by NCSCA
First Name *
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Last Name *
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Are you a current NCSCA Board Member?
Email Address *
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Job Title *
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Institution/ Organization Name *
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Work Telephone Number *
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Cellular Number
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Is this your first time participating in a Legislative Day sponsored by NCSCA? *
Which region or district do you currently work in? *
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