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Name *

First Name

Last Name

Contact *

(###)

###

####

Pricing

Non-Profit

Paid Speaker

N/A

Type of Event *

In-Person

Virtual

Will the event be professionally recorded?

Yes

No

Are you purchasing books or other merchandise for participants?

Yes

No

Will your organization cover travel & lodging expenses? *

(For events outside of Jacksonville, FL)

Yes

No

N/A