ATigney.Solutions
Request ATigney Solutions Speakers / Services
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Name: *
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First Name
Last Name
Address: *
Address
Address Line 2
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District of Columbia
Florida
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Washington
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Northwest Territory
Nova Scotia
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Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
City
State
Zip Code
Phone: *
required
Phone Number
Email: *
required
Email Address
Indicate what speaker you are requesting: *
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What services are you requesting? (i.e. speaking, dancing, singing) *
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Event Description
Organization: *
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Event Start Date: *
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Click in box to select date
Event End Date: *
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Click in box to select date
What is the start time of the event?
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Click in box to select time
Theme: *
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Time allotted for presentation: *
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45 min - 1hr
1hr - 2hr
All day event
Multiple days
Location of the event: *
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*
Address
Address Line 2
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Marshall Islands
Micronesia
Northern Marianas
Palau
Puerto Rico
Trust Territories
Virgin Islands
Armed Forces(AA)
Armed Forces(AE)
Armed Forces(AP)
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territory
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
City
State
Zip Code
Please list the details of your event / request including your desired outcomes: *
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Honorarium Provided ? *
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Yes
No
Projected (Desired) Attendance: *
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1-50
50-100
100-200
200-500
500+
Preparation Requirements
Will the event be recorded?
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Yes
No
Is there overhead projector capability? *
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Yes
No
Are product sales / announcements allowed? *
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Yes
No
Point of contact and phone number: *
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* required