Campaign Speaker Request

Coordinators Name
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Department
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UAB Phone Number
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UAB Email Address
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Meeting Date and Time

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Alternate Meeting Date and Time

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Parking Information for Speaker (Indicate if parking is available & where)
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Meeting Location (Building, Floor, Room)
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Focus of Speech
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Specific Agency or Topic Requested
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Audience
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Size of Group
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Length of time for presentation
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Is a computer and projector available
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Additional comments or instructions
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Please complete for spam protection(*)
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