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  • Event Dates and Times *
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  • Enter the event dates and times*
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  • Name of Person Requesting Darrell *
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  • First*
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  • Last*
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  • Email*
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  • Phone Number*
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  • Organization*
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  •   Organization's mailing address
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  • Street Address*
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  • Address 2*
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  • City*
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  • State / Region*
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  • Country*
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  • Postal / Zip Code*
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  •   Event Information
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  • *
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  • If other, what type of event?*
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  • Event title*
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  • Event location*
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  • Event attire*
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  • Venue type*to order
    Indoor
    Outdoor
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  • Event theme*
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  • Estimated attendance*
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  • Location of the nearest airport*
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  •   The Message
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  • How many times will Darrell speak?*
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  • Please list dates and times you are requesting Darrell to speak*
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  • How long would you like Darrell to speak?*
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  •   Additional Information
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  • Is there a budget for Honorarium, Travel, and Accommodations?*
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  • What is the budgeted honorarium?
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  • $ Dollars*
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  • Cents*
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  • Is there other significant information you would like to share to help us with the evaluation?*
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