Event / Speaker Request Form

Event Contact Person*
Person requesting requires organizational authority:*
If unsure, just provide as much detail as you can about what you're expecting from this event.
Please feel free to estimate if you aren't sure yet.
Please feel free to estimate if you aren't sure yet.
Please feel free to estimate if you aren't sure yet.
Please feel free to estimate if you aren't sure yet.
Event Location Address*
Requested Speaker*
Will women be attending?*
Will you be covering travel, room, and food expenses?

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