Community Presentation Request

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* 1. First and Last Name

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* 2. Job title

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* 3. Organisation/ Business

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* 4. What date and time would like our presence?

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* 5. Address for presentation or stall

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* 6. Contact Person

Name

Email address

Phone number

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* 7. What type of engagement would you like us to provide?

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* 8. If you picked other, please specify here

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* 9. If you chose workshop or presentation, which topic are you interested in?

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* 10. If you picked other, please specify here

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* 11. Who is the presentation for?

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* 12. If you picked other, please specify here

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* 13. Expected number of attendees?

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* 14. Will there be access to internet, power and screen?

Yes

No

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* 15. Any other comments?