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Request for Speaking Engagement

Please print the form and mail or fax to:

Oliver Goodall
c/o TAILAC
P.O. BOX 451960
Los Angeles, CA 90045
Fax: 626-398-7699


Name of person making request: First:
Last:
Name of organization making request:
Requester's office phone:
Requester's office fax:
Organization's mailing address:
Address Presentation to take place:
Number of people in attendance:
Age group of people at presentation:
Date of presentation:
Start time:
Will honorarium be donated?:
Message:

 

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