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"REQUEST A PRESENTER" FORM

For a presentation to your group, please fill in this form

 

 Presentation Request

 
Name
Contact name of person making the request

Organization
Name of the Group or School to whom the presentation will be given

Address
County and/or City where the presentation will be given

Attendence
Number of people attending

Date1
Prefererred day and time for the Presentation

Date2
Second choice of day and time for the Presentation

Date3
Third choice of day and time for the Presentation

DayPhone
Daytime Telephone Number

NightPhone
Nighttime Telephone Number

Email
Contact e-mail address

Fax
Fax Number