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If you would like 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 announcement about ITJ will
be sent to you by electronic mail.
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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