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Speaker Request for Jerome Moore
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Email
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Name of Requesting Individual/Organization
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Event Sponsors (If Applicable):
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Point of contact information: Name, Title, & Phone Number.
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Event Name
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Event Date
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Event Start Time
Time
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Event End Time
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Event /Organization Website
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Event Address/Venue ( (city, state, building, room, etc.)
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Event Objective ( Theme/Topic)
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Number of People Expected to Attend
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Event Type ( Keynote, Conference, Dinner, Panel, Debate, ect..)
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Services Need
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Speaker
Host/Emcee
Moderator
Other:
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Is there a budget for requested services?
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Any other details to add?
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