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Contact Information



College Speaking Event Request Form:
Fill out the information below and press the "send your request" button to send.

Contact Information:
First Name:

Last Name:

Telephone Number:


123-456-7890

Fax Number:
E-Mail Address:
Event Information:
Date(s) you would like to have Dennis Marcellino speak and/or perform music:



Location of Event:
(college, conference center, etc.):

Address
City:
State:
Name of Event:

Expected Audience Size:

FEES: Indicate amount in your budget for Dennis to speak and/or perform music at your event.

Dennis Marcellino Speeches and Music:
I am interested in these topics...
Speech Topic #1:
What Every College Student Needs to Know about Alcohol and Drugs
Speech Topic #2:
Self-Esteem Improvement for College Students
Speech Topic #3:
A “Major” Decision: Choosing the Right Major for You
Music for Concerts and Events (without speech)
Other Information:

Special note or requests:
.


Please note that by requesting this information you are not obligated in any way.


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