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If you want to be kept informed
about developments at the Institute and to learn when
courses are open for general admission, please complete the
following two-part form. Information and announcements about
ITJ will be sent to you by electronic mail. The items
in bold are required for the form to be
processed.
To protect your privacy, the
information you provide will not be released to
organizations that are not part of
The Laurasian Institution.
Contact Information:
First Name:
, Initial:
Last Name:
School System:
E-Mail
Address:
(For example: name@mail.domain.name )
Postal Address
1:
Postal Address 2:
City/Town:
US State (two letter code):
or Province:
Postal Code:
Country (select from list.)
Telephone:
Fax:
If you live in a country other than the United States or
Canada, please use this format for your phone and fax
numbers: (country code)(area code)(number)
Professional Information:
Profession:
If you selected "other", please enter your profession
here:
How did you learn about ITJ:
If you selected "other", please
enter the information here:
What interests you most
about ITJ? (Select the
three most important reasons.)
Thank you for completing
and submitting this form. You will now start to occasionally
receive announcements and information about ITJ by
electronic mail.
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