2018 M21 Presentation/Display Request
Thank you for requesting us at your event. Please fill out the following form so that we can best meet your goals for your participants.

Please Note: For request outside of the Olmsted County area Mission 21 normally requests a stipend for the presenter as well as a donation to Mission 21. Our normal request is $75.00 to the presenter and a suggested donation of $75.00 to Mission 21. Please let me know if you have questions or concerns about this request. Some restrictions apply based on location and days.

Name of Group or Organization *
Your answer
Date of Event : *
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YYYY
Start Time *
Time
:
End Time *
Time
:
Presentation Need *
Location of Event *
Your answer
Number of Anticipated Participants
Your answer
Details of Request: Please include information on your audience. *
Your answer
Type of Technology Available: *
Required
Contact person for event *
Your answer
Contact Email *
Your answer
Contact Phone *
Your answer
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