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Speaking Details
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Name
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First
Last
Phone
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Email
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What impact or result do you seek from the presentation?
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Date of Presentation
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Meeting starts at
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Will the presentation be virtual?
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Presentation Address
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City
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Anticipated total number in the audience
Selected Value:
10
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Audience Characteristics
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25 & under
26-35
36-45
46-55
56-65
66+
(Check top three age-range groups.)
Gender
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Profession
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Please check all that apply. You will provide.
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Microphone
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Other things you will provide
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