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Dr. Lucy Jones Speaker Request Form
Please complete this form to initiate a request to have Dr. Lucy Jones speak at your event.
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Your First Name
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Your answer
Your Last Name
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Your answer
Your Title
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Your answer
Your Organization
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Your answer
Organization Type
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Choose
Association
Book Festival
Church / Religious Organization
College / University
Corporation
Event Producer / Organizer
Government
Grade School (K-8)
High School (9-12)
Non-Profit
Library
Speakers Bureau
Town Hall
Other
City & State
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Your answer
ZIP Code
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Your answer
Email Address
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Your answer
Phone Number
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Your answer
Budget for Speaker's Fees
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$3,000-$5,000
$5,000-$10,000
$10,000-$20,000
$20,000-$40,000
Over $40,000
Other:
Meeting/Event Title
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Your answer
Event Date or Season
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Your answer
Event Venue Name
Your answer
Event Venue City and State (and country if outside of the U.S.)
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Your answer
Tell us more about your event audience: estimated number of attendees, type of attendees, etc.
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Your answer
What topic(s) are you interested in having Dr. Jones Speak on?
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Which speakers, if any, have you hosted in the past?
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