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SPEAKER REQUEST FORM - DOC by yoursovain

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									                                             SPEAKER REQUEST
                                             FORM
Contact Name:

Contact Number:

Contact Email:

Organization Name:

Date of Event (if flexible please indicate range):

Time of Event:

Location of Event (please include full address):



Audience Size:

Purpose of Event:



Specific speaker requested? Specific topics to cover?



Can you provide a stipend for the speaker?

Can you cover travel expenses for the speaker?


 *California Crime Victims for Alternatives to the Death Penalty cannot guarantee that a speaker will be available
                                          on the dates that you request.
             Please return this form to California Crime Victims for Alternatives to the Death Penalty:
  c/o Death Penalty Focus ♦ 870 Market St. Ste. 859 San Francisco, CA 94102 ♦ Tel. 415.262.0082 ♦ Fax 415.243.0994

								
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