Name *

Email *

Organization *

Event Name *

Event Date *

Location*
In-Person Virtual

Expected Audience Size *

Speaking Topic *
Upcoming Elections/What's on the Ballot Election Security Campaign Finance Running for Office
Civics/How Government Works Other

Approximate Meeting Length = Approximate Speaking Time *

A/V Equipment Available? *(projector, mic, etc.)

Preferred Speaker*
Tom Collins Avery Xola Gina Roberts No Preference

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