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(name of the event, length of speech, attire for event, format, topic, luncheon, dinner, reception or theater style seating) DO NOT INSERT PRESS RELEASE
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(include all invited and confirmation status)
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Please provide a description (i.e. size, ceo, employees, etc)
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Organization Will Cover Expenses
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Expenses Covered By Organization
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Speaker will have products (book, tapes, etc.) available for your event. Would you be willing to provide 2-3 people to help sell Speaker’s products?
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Honorarium
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Name
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Primary Contact's Email Address
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Primary Contact's Phone Number
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Primary Contact's Mobile Phone
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Secondary Contact's Name
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Secondary Contact's Email
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Secondary Contact's Email Address
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Secondary Contact's Phone Number
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Secondary Contact's Mobile Phone
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Name of Organization
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Organization Website
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Organization Type
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Organization Industry
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If other
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Additional Organization Details
Role in event
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Prospective Date of Event -- First Choice Date
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Second Choice Date
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Keynote Topic
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Event Start Time
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Event Name
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Panel Topic
Panelists: Specific Names and Affiliation
Venue Name
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Address
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Closest Airport To Venue
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Audience
What media outlets (radio, television, newspaper) will be present at this event?
How is the event being promoted?
Organization Will Cover Expenses
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Expenses Covered By Organization
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Speaker will have products (book, tapes, etc.) available for your event. Would you be willing to provide 2-3 people to help sell Speaker’s products?
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Honorarium
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What is your budget for a speaker?
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Deadline for Response
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