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Collaboration/Speaker Request
Please complete this form to request information about the availability and services of The Privilege Institute and/or Dr. Eddie Moore Jr. Please allow 3-5 business days for response.
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Email
*
Your email
Name of Organization
*
Your answer
First and Last Name of Requester
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Your answer
Title / Department
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Your answer
What service are you requesting?
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Interview
Keynote
Panel Discussion
Workshop
Training
Permission to use the 21 Day Racial Equity Habit Building Resources
Unsure/Consultation
Other:
Are you requesting services from:
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Dr. Eddie Moore Jr / America & Moore LLC
The Privilege Institute (501c3 / Non-Profit)
Unsure / N/A
Logistics
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In Person Event
Virtual - Live Event (not recorded or shared on social media)
Virtual - Live Event (recorded and/or shared on social media)
Mix of in-person and virtual
Other:
Frequency
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One time event
Multiple days/times
Unsure
Required
List Date(s)/Time(s) requested
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Your answer
What is your budget?
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Your answer
Who is your audience?
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Your answer
Brief description of request
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Your answer
Submit
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