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Date |
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Name |
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Title |
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Organization |
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Street Address |
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Address (cont.) |
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City |
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Statee |
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Zip/Postal Code |
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Country |
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Work Phone |
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Home Phone |
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FAX |
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E-mail |
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URL |
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Do you wish to personally appear on the show or Call in? |
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What show Date (s) do you wish to participate in? |
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List all topics here you feel might be worth
covering during your part of the show.
Also, list any fund raising events you are planning. |
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List all your awards, accomplishments, credentials,
degrees, etc. that may be helpful in promoting your part of the show before,
during, and after the actual show time. |
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List any civic, sports, awards, or other organizations you belong to. |
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List personal information like family, where you were born, grew up,
hobbies, etc. |
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List your position and titles, work history, etc. |
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List who or what referred you about being on the show |
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Your Current Employer |
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