Abolition Ohio Speaker Request Form
Name: *
First and Last
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Name of Host Organization:
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E-mail: *
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Phone: *
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Event Name:
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Event Date:
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DD
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Time
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Event Type (Select all that apply):
Venue Name and Address: *
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Event Description:
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Audience type (select all that apply): *
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Expected Number in Attendance:
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Presentation Length of Time (minutes):
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Comments or Special Requests:
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