First Name
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Last Name
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Pronouns
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Email
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Phone
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What type of event is this?
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Description of Event
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Expected Reach
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Date of Event
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Is this a paid speaking opportunity?
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I support Black lives, and am committed to building an inclusive and anti-racist business
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Yes, and I am a-okay with the world knowing it.
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I support LGBTQIA+ rights and the rights of all intersectional identities
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Yes, and I am a-okay with the world knowing it.
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Anything else?
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