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Diversity Speakers Bureau Data Form

Your Name:
Address:
City: State: Zip:
Phone:
Email:
Photo:
Area of Knowledge:
Type of Experience (check all that apply):
Traveled in that area Lived in that area for more than 1 year Speak the Language
Studied the Culture Formally Originated from the Culture
Program Offered: K-8 grade 9-12 grade Adult Audience
AV Needs:
Why do you feel it is important to understand this culture?
Any Additional Information:
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