Affiliate - PAGE Speakers Bureau Reimbursement Form
Name of Speaker *
Your answer
Speaker Address for Reimbursement *
Your answer
Affiliate Location for Presentation *
Name of Speaker *
Name of Presentation *
Your answer
Date of Presentation *
MM
/
DD
/
YYYY
Please Rate the Presenter *
Excellent
Very Good
Good
Poor
Ease of scheduling
Communication prior to presentation
Effectiveness of Presentation
Presentation topic and content was as described
Likelihood of inviting the speaker for another session
Overall rating
Why did you select this speaker? *
Your answer
Any Additional Comments
Your answer
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