Request a St James Infirmary Speaker

A St James Infirmary Speakers Bureau representative will review your request and contact you. Please note all requests will take up to 2 weeks to process, so please plan your event accordingly. If a response to your request is not within 30 day of your initial request date, please contact Kalash Ka Fae, CMT, MSW, ELC at volunteer@stjamesinfirmary.org.

Date of Presentation:

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* 4. Date of Presentation:

Audiovisual Capabilities (please provide special notes and instructions)

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* 7. Audiovisual Capabilities (please provide special notes and instructions)

Host Organization Web Address:

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* 11. Host Organization Web Address:

Host Organization Address

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* 12. Host Organization Address

Host Organization Mailing Address (if different from above):

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* 13. Host Organization Mailing Address (if different from above):

Name and Pronoun of Host Contact Person (how do you gender identify?; i.e.: she, he, they, first person, etc.):

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* 14. Name and Pronoun of Host Contact Person (how do you gender identify?; i.e.: she, he, they, first person, etc.):

Email Address:

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* 15. Email Address:

Day/Evening Time Phone Number:

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* 16. Day/Evening Time Phone Number:

Best times to call:
(please include your global time zone)

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* 17. Best times to call:
(please include your global time zone)

Event Address

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* 18. Event Address

Objective/Theme of Event:

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* 19. Objective/Theme of Event:

Agenda
Please copy and paste agenda into space below.
(if applicable)

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* 20. Agenda
Please copy and paste agenda into space below.
(if applicable)

Additional information about your event you would like to share:

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* 21. Additional information about your event you would like to share:

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