Community Speaker Presentation Request

Organisation Details

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* 1. Group or Organisation Name

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* 2. Contact Person

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* 3. Email Address

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* 4. Phone Number

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* 5. Friend of COTA Organisation

Yes

No

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* 6. Organisation Type

Seniors clubs, or group that comprise of older people (eg U3As, Probus etc)

State-wide organisation, peak body, NGOs

Local Government, Education Institutions

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* 7. Where did you hear about the COTA NSW Community Speakers program?