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Request a Speaker

To request a speaker through the Shands Speakers Resource Program, please call (352) 265-0373 or fill out the form below. Please allow at least two weeks to fill your request.

*First name
*Last name
*E-mail address
*Confirm e-mail address
Phone number
(area code first)

Topic of Interest

Topic of Interest 2

Topic of Interest 3

Date of Presentation

Time of presentation

Length of presentation

Organization/Group Name

Approximate number of participants

Target audience


* Indicates a required field.

Thank You! Please allow at least two weeks to fill your request.

 

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