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USETDA Regional Representative Application Form
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Nominee's Name
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Nominee's Email Address
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Nominee's Institution
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Nominee's Role in the ETD Process and Job Title
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How long have they been in their current role?
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Why are you interested in serving as a Regional Representative? If you are nominating someone other than yourself, please describe why you feel that they would be a good Regional Representative.
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If you are nominating someone other than yourself, please include your name and email address below.
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