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Jacinto "Cinto" Ramos, Jr Speaking Request Form
Event Contact Person's Name and Title *
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Name of your Company/Organization? *
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Contact Person's Phone Number *
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Purpose of the Event *
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Event Date *
MM
/
DD
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YYYY
Please Provide the Organization/Event Website
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Event Location (Please provide name and address) *
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Contact Person's Email *
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How long would like Jacinto to speak? What time would like him to arrive? *
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What time would you like Jacinto to speak? *
Time
:
What is the Requested Topic? *
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What exactly would you like Jacinto to do? (Keynote, Conference Workshop, Private Seminar, etc.) *
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Please provide a bit of information about the audience. (College-age, parents, etc.) *
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What is your proposed Honorarium? *
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Is travel/lodging included for Jacinto? What is the closest airport? Will transportation and/or meals be provided? (Jacinto travels from Dallas)
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Do you require a Bio and Headshot? *
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