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* 1. We would like to find out about your interest and availability to speak publicly about play and play-related issues. As our Coalition raises awareness of the importance of play to a wide range of audiences, we are seeking like-minded individuals who can participate in panel discussions, be quoted for news articles, or speak to groups about the need and benefits of children's play for their growth and development. Please take 8 minutes to fill out this brief survey about yourself and topics you might speak on.

Are you interested/available to speak on topics which will educate others or raise their awareness of the importance of play? (check all boxes that apply)

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* 2. What topics could you speak on as an "expert"? (check as many as apply)

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* 3. How long are you willing to speak ? (check all that apply)

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* 4. How far are you willing to travel to get to a speaking engagement?

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* 5. What kind of audience would you feel comfortable addressing? (check all that apply)

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* 6. What is your availability to speak? (check all answers that apply)

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* 7. What materials or set-up would you require? Be sure to include AV equipment, need for copies, or any particular room arrangement that works best for you.

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* 8. Tell us more about your qualifications as a speaker. Please include any special degrees or licenses you hold, what organization you represent (if any), and speaking experience.

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* 9. Thank you for being willing to speak to others about the importance of play! What is the best way for us to contact you? Please include your phone number(s), email and mailing address.

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* 10. Can you recommend anyone else who would be a good speaker on the subject of play?

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