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BOOKING REQUEST

If you would like to book C. Regi Rodgers, fill out the request form below.

Name*

Email Address*

Name of Organization*

Telephone/Mobile*

Address*

Event Title*

Event Start Date

Event End Date

Event Location*

Please specify the event's format

Is this event

(Answer only If Ticketed) Is the event going to

The Audience will be

Available audio-visual equipment

Theme of event or Expected Topic of Discussion

Expected duration of Speech/Workshop

Expected number pf members/guests in the audience

Any other Speakers/Officials attending the event

If yes, please provide details

Is there a Speaker budget you are trying to meet? Please Specify

Details on Travel & Accommodation Arrangements.

Additional Information

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