JQ Speakers Bureau Request Form
Name of Organization
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Type of Organization
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Address
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City
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State
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Zipcode
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Contact Name
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Contact Phone Number
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Contact Email
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Organization's Website
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Date of Proposed Speaking Event
MM
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DD
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YYYY
What group within your organization will the speaker present to?
Topic/Focus of Speaking Engagement
For additional ideas of topics, please see the JQ Speakers Bureau Brochure for a list of speakers and topics they speak about.
Number of People Expected to Attend
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Additional information needed by JQ International or the speaker
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