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blaq noyz, LLC
Interest Form for Services
this is the first step in requesting public services from mothasistah.
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* Indicates required question
FULL name (first, last)
*
Your answer
email address for contact
*
Your answer
state of residence/company
*
Your answer
what service(s) are you interested in mothasistah providing?
*
panelist
keynote speaker
facilitation/training
master of ceremonies
handbook/curriculum modification
mediation
medical/provider advocacy
Other:
Required
scheduling for events should be at least a MONTH in advance for mothasistah's research and prep. what date are you looking for the service(s) to delivered?
*
Your answer
what days are you best available for a pre-meeting to discuss logistics?
*
weekday mornings
weekday afternoons
weekday evenings
Saturdays
Sundays
Required
Provide any notes you need to share surrounding your request for services.
Your answer
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