Kymone Hinds Request Form
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LOCATION *
What is your suggested Honorarium? *
DATE OF EVENT *
MM
/
DD
/
YYYY
NAME OF SPONSORING ORGANIZATION *
TITLE OF EVENT *
How many Presentations is he expected to present? *
TYPE OF ORGANIZATION *
HOW WOULD YOU LIKE HIM TO PARTICIPATE? *
Name *
Title *
Email address *
Phone Number- *
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