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Name of Organization

Authorized contact person (and title)

Full Mailing address

Phone
Fax
E-Mail
Web Site

Desired program date:
Secondary date:

Presentation setting:

church sanctuary

classroom
auditorium
theater

Desired message or seminar presentation (description or title)
True Riches
Other:

Type of presentation desired:
general presentation
leadership workshop
graduating commencement address
Other:

Desired length of program:
20-30 minutes
30-45 minutes
45-60 minutes
60-75 minutes
75-90 minutes
Other:

Anticipated time of presentation:

Anticipated audience:
20 - 50
51 - 75
76 - 100
101 - 250
251 - 500
501 or greater

Average age

college students
business professionals
Other:

Anticipated budget for speaker's fee and travel expenses:

Airport to fly into:

Distance from airport to event:
miles

How did you learn about this event:

Any additional details:




 


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