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Requester's Emails:*

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Requester's Agency:

Adult Education:

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Date(s) Requested*

Please specify how much time is available for the presentation.

Time Frame:*

Please enter a number from .5 to 6.

Please specify how much time is available for the presentation, in half-hour increments. (example: .5, 1.5, 2.5)

Requested Language for Training:*

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Estimated Number of Attendees:*

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Profession of Attendees:*

Purpose of the meeting/training:*

How did you hear about our program?*

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