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* 1. Name of presenter:

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* 2. Title of presenter:

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* 3. Cell phone number with area code:

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* 4. Email address:

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* 5. Length of workshop: 50 minutes or 75 minutes

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* 6. *Date Requested:
April 2 between 6:30-8:30 PM
April 4 between 10 AM -12 PM
April 9 between 6:30-8:30 PM
April 11 between 10 AM -12 PM
April 16 between 6:30-8:30 PM
April 18 between 10 AM -12 PM
*Write 1st Choice and 2nd Choice on the date/time that corresponds to your preference.

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* 7. Set-up style:

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* 8. Workshop title:

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* 9. 50-word description of workshop:

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* 10. 50-word biographical statement for presenter:

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* 11. A/V needs: Please keep to a minimum!

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* 12. Email current head-shot to Kristi@HopeAtHand.org 
No sunglasses, please! Professional or playful head-shots welcome.

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* 13. I grant Jax Poetry Fest the perpetual, nonexclusive, royalty-free right and license to: • Record, reproduce or distribute my participation and appearance on digital/film photography, video, audio and/or other mediums • Use my name, likeness, voice and biographical material and information in connection with all Jax Poetry Fest written, electronic, web publications and social media. •I am voluntarily making this grant of rights. I further agree to release and forever discharge Jax Poetry Fest, its agents, employees and designated representatives from any and all claims in law or equity that I, my heirs or personal representatives have or shall have arising as a result of  my participation in Jax Poetry Fest. Auto-sign below

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