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Primary Contact Person
*
First
Last
Email Address
*
Phone Number
*
Organization Name
Presentation Types
*
Poetry Performance
Lecture
Keynote
Panelist
MC/Host
Other:
Speaking Fee/Honorarium Budget (not including travel accommodations) *
*
Event Location
*
Event Description
*
Event Date (mm/dd/yyyy)
Event Time (hh-mm, AM/PM)
Expected Number of Attendees
*
Duration of Performance/Speaking
*
Travel/Lodging Accommodated? *
*
Yes
No
Dress Code
*
Formal
Casual
Q&A Session following event *
*
Yes
No
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