1. If you are interested in having Dr. Brewer come speak with your organization, please provide the following information

  2. All fields marked * are required
  3. Your name*
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  4. Name of your organization/group*
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  5. Contact information for this request*
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  6. Are you a non-profit?*
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  7. Briefly describe your group/agency goals.*
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  8. Topics you would like Dr. Brewer to discuss.*
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  9. Date*
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  10. Time*
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  11. Address*
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  12. Transport Provided?
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  13. Fee/honorarium*
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  14. Security*
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