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Name of Primary Contact *
Name of Primary Contact
Phone Number of Primary Contact *
Phone Number of Primary Contact
Preferred Speaking Format *
Location of Speaking Event *
Location of Speaking Event
Preferred Speaking Date *
Preferred Speaking Date
Preferred Speaking Time *
Preferred Speaking Time
i.e., 30 minutes, 60 minutes, 90 minutes, etc.
$
Will I be able to use PowerPoint? If so, how should I submit them to you? *