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Speaking Questionnaire for Reggie Cochran

If you are interested in having Reggie Cochran speak or train at one of your events, please completely fill out the following questionnaire.

Name of company, event, school, college etc. that you represent.
Your name & title.
Your mailing address, email address & phone number
Date & location of where you want Dr. Reg to speak.
@ number of attendees you expect at this event.
Length of speech / presentation you're interested in.
What is your speaker budget?
How did you hear about Reg?
What do you want Dr. Reg to help you accomplish by speaking or training at your event?
Your Name:
Your Email: