Inquiring to be a speaker for The Academy SPS
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Your Full Name (First & Last): *
Address (Street, City, State, Zip) *
Email address (if different than one above)
Phone Number (indicate if cell/work/home) *
Affiliate/Company *
Topic/Subject(s) of Choice:
Previous Speaking Engagements or Experience:
Have you presented to The Academy before? If so, when and at what capacity?
Availability (check all that applies) *
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