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Human Performance Laboratory Contact Information Form

First Name:

MI:

Last Name:

Suffix:

Date of Birth:

Sex:

Female

Male

Ethnicity:

Address

City/Town

State/Province

ZIP/Postal Code

Country

Home Phone:

Cell Phone:

Work Phone:

Email:

Emergency Contact:

Name:

Relationship:

Primary Phone:

Interested in

Please answer the following questions:

Are you currently part-time or full-time employee of SFU?

Are you currently enrolled (≥ 6 credits) as an SFU Student

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