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Emily Knox Speaker Request Form
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Email
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Your email
Your Organization
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Your answer
Your Name
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Your answer
Email
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Your answer
Phone Number
*
Your answer
Name of Event
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Your answer
Theme or Focus of Event
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Your answer
Scheduling (Dates/Times)
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Your answer
Type of Presentation (Keynote, panel, workshop, etc.)
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Your answer
Expected Number of Attendees
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Your answer
Event Address
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Your answer
Will an honorarium be provided?
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A fee schedule will be provided upon receipt of this form.
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No
Will travel expenses be reimbursed?
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Yes
No
Further Details
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