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Speakers Bureau Request Form

Thank you for your interest in Carroll Hospital Center's Speakers Bureau, a complimentary service that provides speakers to community groups of 20 or more.

Due to physician and staff schedules, please make your requests at least six weeks in advance.

  
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Organization in need of speaker:
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Primary Contact Person:
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Address of Speaking Location:
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Contact Phone:
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Requested Topic:
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Is this date flexible?

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Presentation Time:
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Approximate amount of time allotted for presentation (including a question-and-answer session):
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Number of Expected Attendees:
Audio/Visual Requests: