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* 1. Event Name

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* 2. Event Type

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* 3. Event Date

Date

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* 4. Event Begin Time

Time

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* 5. Event End Time

Time

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* 6. If this is a speaker request, how much time is allotted for the speaker?

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* 7. Contact Person Information

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* 8. Event Location Information

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* 9. Is this event open to the public?

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* 10. Please indicate which items are to be provided by the event host.

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* 11. Information/Speaker Request Topic

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* 12. Estimated Number of Event Attendees

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* 13. If attendees are children, please indicate the age range.

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* 14. Other Event Details that you would like to share.

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* 15. How did you find out about the MLGW Speakers Progam?

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