Name

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Email

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Phone Number

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School/ District/ Business

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Type of Opportunity

Local Conference
State Conference
National Conference
On Site Training

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Attendee Numbers Predicted

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Date of the Event

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Location of the Event

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Description of the Event

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Additional Information such as presentations you know you want to include and/or specific travel information pertaining to hotel, airports, or additional information needed.

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Presentation Request Form for Mary Amoson