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Name:
Email address:
Department:
Conference name:
Conference date(s)*:
(MM/DD/YYYY - MM/DD/YYYY)
*Past dates will be declined. If you have questions, please email Mara Stahl (stahlmar@bc.edu).
Conference location:
(City/town, state/province, & country)
Will you be presenting at this conference?
Yes
No
Presentation title:
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