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NJ Self-Direction Summit - Speaking Submission Form

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* 1. Name

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* 2. Company / Organization Name (Type N/A if not applicable)

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* 4. Phone

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* 5. Which of the following best describes you?

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* 6. What topic are you proposing to speak on?

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* 7. Please provide additional detail on the specific topic you'd like to present - including what you'd like the audience to learn as well as your background / expertise on the topic.

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