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Special Event / Speaker Request Form
What type of event is this?
Professional Conference
Workshop
Church Conference
Online Event
Other
Is this event virtual?
Yes
No
Would you like the speaker to come in-person?
Yes
No
Who would you like to invite to speak or present?
Jefferson Jones, M.Div
Rosa Jones, LPC
Both
What is your budget for speaker honormairm (to include speaker fee, transportation, meals & lodging) ?
$0
$250-500
$500-$1,000
$1,000-$2,500
$2,500+
How did you hear about us?
Facebook
Instagram
TikTok
Google
Referred by Friend
Other
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