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Speaker Information(* means Required Field)
Program Title:*
Program Title
Program Presenters:*
Program Presenters
Presenter Credentials:
Presenter Credentials
Telephone Number:
Telephone Number
E-mail Contact:
Email Contact
Length Of Program:
Length Of Program
Description Of Program Content:
Description Of Program Content
District Areas where Program is available
Area Of Program Availability, for example Areas 9 & 10
Extra Cost: Yes No 
Other than the meal price, is there any cost associated with the program
Extra Amount:
if yes to above, please enter extra amount
PPT Presentation: Yes No 
Include Power Point Presentation?
Equipment Needed:
If so, please describe
Submit Your Name:
Submit Your Name
Submitters Club:
Submitters Club
Submitters Club Position:
Submitters Club Position
Submitters Phone:
Submitters Phone
Submitters Email:
Submitters Email



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The above information is for District 5020, Rotary Clubs in that district or personal use of Rotarians of District 5020 only. The information for each Rotarian may not be used or distributed for any commercial purpose whatsoever without the express permission of that Rotarian.