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GAL Presentation Request eForm

Request Point of Contact
(This question is mandatory)
Name
(This question is mandatory)
Title
(This question is mandatory)
Email
Please confirm that you have entered your email address correctly before continuing.
(This question is mandatory)
Telephone
Requesting Organization
(This question is mandatory)
Name
(This question is mandatory)
Organization Type
(This question is mandatory)
Mailing Address
Presentation Location
(This question is mandatory)
Location Name
(This question is mandatory)
Is the presentation location's address the same as the mailing address entered above?
(This question is mandatory)
Physical Address
Preferred Date and Time
(This question is mandatory)
Date
Open the date time chooser
(This question is mandatory)
Start Time
(This question is mandatory)
How much time is available for the presentation?
Alternative Date and Time
(This question is mandatory)
Date
Open the date time chooser
(This question is mandatory)
Start Time
(This question is mandatory)
How much time is available for the presentation?
Presentation Details
(This question is mandatory)
How many people do you anticipate will attend?
(This question is mandatory)
What is the audience type?
Examples include state employees, retirees and members of an association or civic organization.
Please indicate which items you are able to furnish for the presentation.
Please enter any specific questions that you would like addressed during the presentation.
Finish
Please enter any other questions or comments.
(This question is mandatory)
I hereby certify that this submission contains no privileged or confidential information.
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