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Outreach Request
Please use this form to request a Presentation, Speaker's Bureau panel, or Tabling.
Event Info
Event Title
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Event Description
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Name of Venue
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Address *
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Event Date (Tentative OK)
MM
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DD
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YYYY
Alternative Dates (If Any)
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Event Start time
Time
:
Event End time
Time
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Primary Contact Information
Contact Name *
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Organization Name
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Contact Email
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Contact Phone number
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Preferred method of communication
Parking Instructions
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Event Type
Presentation Details
Only fill out this portion if requesting a presentation or workshop.
Type of Presentaion
Intended Audience
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# of attendees (Estimate)
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Audiovisual Capabilities: Do you have a:
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