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Public Education Activity Requests

  1. EVENT INFORMATION

  2. Type of Visit

  3. AGENCY INFORMATION

  4. BY TYPING YOUR NAME, YOU ARE CERTIFYING THAT YOU HAVE READ AND AGREE WITH THE FOLLOWING STATEMENT IN ITS ENTIRETY.

    I AGREE THAT MY TYPED NAME ON THIS DOCUMENT IS THE LEGALLY BINDING EQUIVALENT TO MY HANDWRITTEN SIGNATURE. I WILL NOT, AT ANY TIME IN THE FUTURE, REPUDIATE THE MEANING OF THIS SIGNATURE OR CLAIM THAT THIS SIGNATURE IS NOT LEGALLY BINDING.

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  6. This field is not part of the form submission.