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NCAA Membership and Student-Athlete Affairs Group Speaking Engagement Request Form

Name of group
requesting a speaker:
Subject of
presentation:
Anticipated number
of attendees:
Position(s) of those
expected to attend:
Date of speaking
engagement:
Time and length
of presentation:
Location of
the function:
Is the group willing
to pay travel expenses?
Yes No
Please explain:

Contact Information

Name:
Title:
Company:
Address:
Phone:
Fax:
E-mail: