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Name

Date

Email Address

Company Name/Organization

Name/Date/Time/Location & Address of Event

Summary of Event

Purpose of Appearance (i.e. Speech 45min-1hr)

For
 Profit

 Non Profit

Sending ...

This is a request for an appearance/speaking engagement for Basheer Jones. This request does not guarantee an appearance. Please allow for 30 days notice. Fax completed form for review and we will contact you to confirm if accepted. Thank you.

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