Guest Speaker Request Form - The Center for Implementation

Thank you for thinking of us! Please complete this form so we can learn more about this opportunity. After receiving these details, we'll get back to you shortly. 


Contact information
Full name
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Email address
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Organization
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Event details

Please provide details about the event for which you are requesting a speaker
Name of event
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Please provide a brief description of the event, its purpose, and intended audience 

Please provide at least 2 sentences to give us a sense of what you are looking for.
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Please provide at least 2 sentences to give us a sense of what you are looking for.
When is the event happening?
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Is the event virtual, in person, or hybrid?
Virtual
In person
Hybrid
Other
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How many attendees are you anticipating?
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