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Victim Services


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Request for Presentation

(Topic you wish to be discussed)

(Dates you would like the presenter to present topic)

(Dates you would like the presenter to present topic if first choice is not available)

(Times you would like the presenter to present topic)

(Place where presenter arrives to present the topic)

(Where contact person can be reached)

(Description of attendees being addressed: i.e.: class, hall, program, etc.)

(Estimated Number of Participants)