*Please note: Only complete one form for the each presentation*

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* 1. Presentation Title:

Please fill out the following information carefully. All requests must receive approval by the AGPA Connect Committee Co-Chairpersons and no later than January 12. Thank you!

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* 2. Name:

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* 3. Type of presentation:

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* 4. Presentation Date(s)

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* 5. Please provide contact information so that we can contact you if there are any questions regarding your request.

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