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The document is the Exhibit Space Order Form for the 19th International Symposium on Capillary Electroseparation Techniques, scheduled from September 30 to October 3, 2012, at the Tremont Grand in Baltimore, Maryland. It outlines the application process for exhibitors, including fees for table-top exhibits and vendor workshops, payment instructions, insurance requirements, and rules and regulations governing the exhibit space. The form also includes details on cancellation policies, security responsibilities, and indemnification clauses.

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