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Request a Speaker - Carroll Hospice

Carroll Hospice is pleased to provide a speaker to present to your organization. Due to staff schedules, please make your requests at least 6 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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Requested presentation date:
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Requested presentation time
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Is this date/time flexible?

Amount of time allotted for presentation (including question-and-answer session):
Number of expected attendees:
Audio/Visual requests: