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Name ________________________________________________________________
Address ______________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Phone (_____)________________________________________ Work
Phone (_____)________________________________________ Home
FAX (_____)_________________________________________
e-mail ______________________________________________
(Circle all that apply):
Activities In Which You Have an Interest (Rank Top 3):
__ Attend Professional Conferences
__ Host Training Workshops
__ Facilitate Job Placement Activities
__ S.A. Suggested Reading Lists
__ Faculty Meeting Representative
__ S.A. Bulletin Board
__ Alumni Locations
__ Compile/Edit Newsletter
__ S.A. Speaker's List
__ Other: __________________________________________________________________
__________________________________________________________________________
Signature:_________________________________________________/Date:_____________
Submit completed form, with a check for $10.00 made out to SAGA, to:
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