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Your Name:
Department/Organization:
Phone:
Email:
Event Title:
Event Time:
Event Location:
Brief Description of Event:
Number of Attendees:
Number of GSE Speakers Needed:
Requested Speaker(s):
Preferred Academic Program(s):
Speaking Time Length:
Will the speaker have access to a computer, projector and screen?
Yes
No
Considering the attendees and event, how would the requested speaker(s) make this presentation a success?
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