Speakers Bureau Session Request Form
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Requestor Name *
Requestor Email *
Requesting for (Club Number or Area/Divison) *
Session Name *
Enter the name of the session (for example Giving and Receiving Feedback, Pathways etc)
Session Date and Time *
MM
/
DD
/
YYYY
Time
:
Preferred Trainer (We will do our best, but no guarantees)
Additional Details
Enter details about what specifically needs to be covered in the topic. Identify areas specific to your target audience.
Disclaimer *
This information will be shared with District 41, Toastmasters International and their affiliates (D41). You agree that D41 cannot control the use of this information and will not be held liable for any possible misuse.
Required
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