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J Penelope Speaker Request
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* Indicates required question
Email
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Your email
First Name
*
Your answer
Last Name
*
Your answer
Location and Audience
*
Your answer
Date of event
*
MM
/
DD
/
YYYY
Event type
*
Webinar
In person
Event website
Your answer
Speaking topic
*
Your answer
Event format
*
Keynote
Panel Discussion
Small Group
Demonstration/Participant Activity
Required
Requested length of presentation
*
Your answer
Is there a speaker budget?
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No
Referred by
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Your answer
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