Speaker Request Form

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* Indicates required question

Name of Organization *

Your answer

Name of Event *

Your answer

Name of Contact Person *

Your answer

E-mail or Phone Number *

Your answer

Date of Event *

Your answer

Time Requested (Start & End) *

Your answer

Location *

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Type of Event

Panel

Workshop

Conference

Class Presentation

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Event Description *

Your answer

No. of people attending event *

Your answer

The event provides:

Stipend

Transportation

Food

Other

Why are you requesting an IYJL speaker? *

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Submit

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