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First name

Last name

Phone Number

Give a brief description of the engagement: event type, audience, goals, etc.

How will Jordan deliver his message?

If already determined, please briefly describe Jordan's engagement commitments

What topic(s) or theme(s) should Jordan address in these engagement(s)?

Event Name

Event Date(s) of Interest

Event Venue Name

Event Venue Address

Event Budget for Speaker (dollar amount required)

Is photography and videography allowed for this engagement

Will the talk be professionally photographed?

Will the talk be professionally videographed?

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