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2. Contact Name*
3. Last Name*
5. Presentation is for
   -- Select One --GroupOrganizationBusinessSchool
6. Name of Group/Organization/School/Business*
7. Audience Size*
9. Address where Speaker will present*
10. Address2
12. City*
14. Phone Number*
15. Email Address*
17. 1st Choice Date/Time*
    1st Choice Date/Time

    1st Choice Date/Time
18. 2nd Choice Date/Time
    2nd Choice Date/Time

    2nd Choice Date/Time
19. Please describe the type of speaker/presentation you'd like to schedule*
21. If you would like a Powerpoint to accompany the presentation, please advise what speaker needs to bring: Laptop, thumbdrive, projector, screen, etc.
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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit Submit and Print

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