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Any personal information that you provide to us using this form is protected by the Privacy Act. It will be used only for the purpose of replying to you and will be retained only for as long as it takes to do that.

For information about the privacy of personal information and the Privacy Act, visit the Privacy Commissioner's website or contact that office at 1-800-282-1376.

Register for the Human and Systems Integration Workshop in Gatineau (Sept. 21-22, 2010)

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For a record of your registration, please print your form before submitting it.