Shante R. Roddy Speaker Request Form
Contact Name
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First Name
Last Name
Email
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Phone Number
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Format: (000) 000-0000.
Name of Event
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Presentation Length
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Event Location/Address
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Date of Event
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Day
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Date
Presentation Start Time
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Hour Minutes
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AM/PM Option
Requested Presentation Type
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Please Select
Address
Guest Speaker
Breakout
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Facilitator
How did you hear about Shante R. Roddy?
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Audience AnalysisOverview of Audience (career professionals, entrepreneurs, single women, etc.)
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Average Age Range of Audience
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What goals or objectives do you want the presentation to address?
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How do you want the audience to feel after the presentation? (ex. inspired, informed, educated , etc.):
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Speaker Budget
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Additional Comments
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Please verify that you are human
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