The Travelling Orator Book Request

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What books are you requesting? (max 3)

1.

2.

3.

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* 4. Where should we send the books?

First line:

Second line (if applicable):

City:

State:

Zip code:

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* 5. Are you able to pay return postage and send back? (If no, we will send prepaid envelope)

Yes

No

Questions or concerns?

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* 6. What is your best contact information?

Email Address

Phone Number