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D. Seles Booking
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* Indicates required question
Organization Name
*
Your answer
Organization Number
*
Your answer
Organization Email Address
*
Your answer
Organization URL
*
If there's no url, type N/A
Your answer
Organization Address:
*
EX: 123 CHERRY STREET
Your answer
Organization City, State & Zip Code
*
EX: Atlanta, GA 36748
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Main Contact First Name:
*
Your answer
Main Contact Last Name:
*
Your answer
Main Contact Number
*
Your answer
Main Contact Email
*
Your answer
Date of the Event
*
MM
/
DD
/
YYYY
Time of the Event:
*
Time
:
AM
PM
Estimated time for presentation:
*
Time
:
AM
PM
How long is the presentation:
*
Ex: Set will be 30mins
Your answer
Is there a specific theme:
*
If yes, please list details below. If no, please type: N/Ax
Your answer
Will you need photos of for promotions?
*
If yes, a photo will be emailed to you for promotions. We ask that no photo be pulled from any social media accounts.
Yes
No
Speaker budget
*
$500
$1000
$1000+
Additional Information
*
Your answer
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