Speakers Bureau Request Form
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Organization(s) hosting the event *
Title of Event *
Date of Event *
Time of Event *
What is the expected number of attendees? *
Address of Event *
Name of contact person *
Email address of contact person *
How long will PTV22 be expected to present? *
Will PTV22 be able to share a powerpoint slide?  (Please advise if PTV22 needs to provide any AV equipment to make this possible.)
Phone number of contact person *
Has press been invited? *
Is there any other information you'd like noted in your request?
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