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STAP Education/Outreach Program Request
Please be aware that program requests should be submitted at least 8 weeks in advance, if possible, in order to ensure staff availability.  In the event that you are submitting a request without sufficient notice, it may not be possible to schedule a staff member or speaker for the date you have listed.
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Email *
Date of Event *
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Time of Event *
Time
:
Location of Program *
Name of Person Requesting Program *
Best Contact Phone Number *
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