The Providence Speakers Bureau
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Requestor information:
Name:
Phone Number:
Email address:
Organization:
Event Information:
Date:
Alternative Dates:
Time:
Length of Presentation:
Location:
Number of people expected to attend:
Speaker Topic requested:
Aging/senior care
Cancer
Dementia and memory loss disorders
Diabetes
Heart health
Men’s health
Mood disorders
Nutrition
Obstetrics and gynecology
Pediatrics
Seasonal affective disorde
Sexual abuse
Sleep disorders
Sports medicine and rehabilitation
Stoke and stroke rehabilitation
Substance abuse
Wellness
Women’s health
Other topic
What audio/visual equipment will be available at the event? (laptop, projector, screen, podium with microphone, etc.):
Additional Information: