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Community Outreach
Speakers Bureau - Request a Speaker

We require an audience of 20 or more. We are limited to venues within a 40 mile radius of Ann Arbor.

Group Name:
Today's Date:
Contact Person
Contact Name:
Address:
City & State:
Zip:
Daytime Phone:
Fax:
Email:
Topic Preference
First Choice:
Second Choice:
Event Details
Date:
Time:
Location:
Indicate expected length of talk:	30 minutes One hour 90 minutes Two hours
Indicate expected audience size:

updated 01/2011

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