Future Directions in Quantum Information Processing Workshop

Title (Mr., Mrs., Ms., Dr., Lt., etc.)

First Name

Last Name

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Organization Name

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Department/Division

Organization Address

Organization City

Organization State

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Phone Number

Your Research/Lab Webpage URL

Short Bio (<200 words)

Do you request a travel stipend?

Are you a US citizen/permanent resident?

Lunch will be provided however we want to acknowledge any dietary restrictions, do you require a vegetarian fare?

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