LORI L HAYES
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Keynote
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About Lori
What Are People Saying?
Contact Lori
Press Kit
Home
Keynote
Workshops
About Lori
What Are People Saying?
Contact Lori
Press Kit
Pre-Questionnaire
*
Indicates required field
Organization
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Please specify organization type (i.e student council, NHS, etc)
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Conference Theme
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Conference Website
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Contact Person
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First
Last
Email
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Phone Number
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Mailing Address
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Line 1
Line 2
City
State
Zip Code
Country
Closest Airport
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Distance From Airport
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Conference Address If different then mailing address
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Line 1
Line 2
City
State
Zip Code
Country
Conference Hotel
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Line 1
Line 2
City
State
Zip Code
Country
Dress Code
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Casual (Jeans)
Business Casual (Business Attire)
Formal
Other
Technology Assessment
Sound Technician
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Yes
NO
WiFi
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Yes
No
Projector Screen
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Yes
No
Mircrophone
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Handheld
Cordless Handheld
Lavlier
Other
Please specify other
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Presentation Request
Day of the Week
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Saturday
Sunday
Monday
Tuesday
Friday
Saturday
Sunday
Requested Date
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Start Time
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End Time
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Presentation Request
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Keynote
Workshop
Training
Summer Camp
Boot Camp
Audience
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Students
Adults
Parents
Administrators
Adults & Students
Other
Other
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Age range of attendees
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# of Participants
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Presentation Facility
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Arena
Auditorium
Gymnasium
Ballroom
Classroom
Other
Day of the Week
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Saturday
Sunday
Monday
Tuesday
Wedensday
Thursday
Friday
Requested Date
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Start Time
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End Time
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Additional Presentation Request
Select One
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Keynote
Workshop
Training
Summer Camp
Boot Camp
Select One
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Students
Adults
Parents
Administrators
Adults & Students
Other
Other
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Age Range of Attendees
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# of Participants
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Presentation Facility
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Arena
Auditorium
Gymnasium
Ballroom
Classroom
Other
Are there any pre-meeting engagements (i.e. breakfast or lunch)?
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YES
NO
Please provide time, location and type for pre-meeting.
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Presentation Goals
What is the purpose of the event?
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Are there any sensitive topics that Lori L should not speak on?
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"At the conclusion of the event I would like participants to..."
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Please provide any additional information you would like Lori L to know prior to your assembly/ event.
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Budget Allocated for Speaker
*
Submit