Need a Dynamic, Charismatic, and Informative Speaker or Moderator?

Contact Name *

First Name

Last Name

Contact Phone Number

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###

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Preferred method of contact *

Email

Phone

Date of Event *

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DD

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Virtual Event? *

Yes

No

Expenses Covered by Organization (if applicable)

Flight, train, etc.

Ground Transportation

Hotel Accommodations

Deadline to respond

Minimum 2 week lead time

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