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Mallory Cyr Speaker/Consulting Request Form
Please fill out the following information, as well as anything that would be helpful for Mallory to know. Once the form is received, Mallory will be in touch to provide a quote for services and set up a time to further discuss the needs of your audience.

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Email *
Organization: *
What is the date of your event? *
Is the event virtual, or in person?
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What time would you like Mallory to present? *
Is this time flexible? *
What type of presentation do you want Mallory to provide? (Please visit for further definitions of services) *
If you said other for the last question, please describe the type of service you are requesting:
Please describe the size and makeup of the audience for this presentation (youth leaders, medical professionals, etc) *
Please provide some dates that work to set up an initial planning call with Mallory and anything else you think would be helpful to prepare.
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