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Lance Croy Booking Form
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* Indicates required question
Email
*
Your email
Primary Contact Name
*
Your answer
Primary Contact Phone Number
*
Your answer
Purpose of the Event
*
Your answer
Date of the Event (Start)
*
MM
/
DD
/
YYYY
Date of the Event (End)
*
MM
/
DD
/
YYYY
Exact Address of the Venue
*
Your answer
How Many Times Will Lance Be Speaking
*
1
2
3
4
Other:
Required
How Long Will The Presentation Need To Be
*
0-20 Min.
25-40 Min.
45-60 Min.
Other:
Required
Renumeration
Yes
No
Honorarium
Travel Expenses
Transportation To/From Venue
Hotel Accommodations
Meal Voucher
Yes
No
Honorarium
Travel Expenses
Transportation To/From Venue
Hotel Accommodations
Meal Voucher
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Any Other Details That May Be Pertinent
Your answer
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