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Request Dr. Kelli
Thank you for your interest in inviting Dr. Kelli to your event. Please complete this form to provide information necessary for an accurate quote. We will get back to you soon. For questions, please email info@braintalkfoundation.org.
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Email
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Your email
Date of Submission
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Contact Name (First and Last)
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Your answer
Contact Person's Title/Role
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Name of Organization
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Phone number
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Date(s) I'm Interested In
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Location of Event (City, State, Venue)
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What is your speaker budget?
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Your answer
Topic(s) I am interested in are:
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Concussion, Traumatic Brain Injury (TBI), & Chronic Traumatic Encephalopathy (CTE)
Rehabilitation: Dementia, Stroke, and/or Parkinson's Disease
Book/Author Event
Other:
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What is the closest airport? (If
applicable)
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Virtual or In-Person?
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In-Person
Virtual
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Length of Session?
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30 minutes
45 minutes
60 minutes
90 minutes
2 Hours
Other:
How many attendees? (Provide an estimate if applicable)
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How did you hear about Dr. Kelli?
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Additional notes/comments:
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Send me a copy of my responses.
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