Please read the statement below then sign this form. Please **DO NOT** share this until it has become public with anyone. Neither the form should be shared with anyone nor the statement below prior to emailing hasib@legacy.institute or speaking to him.
Position & Institution (s), example: Dr.... - Professor, (Name of Institution), Sh. ... - (Name of Institution/Affiliation) - Your name will be added to the Medium statement linked above. *
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The above in Arabic, Farsi, & Pasho (if applicable) *
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Location *
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Email Address *
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