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The Israeli Consulate offers a wide range of speakers in the following categories:

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Speakers Bureau Request Form
Please complete and return this form at least four weeks prior to your event.

Contact Information
Contact Name: (*)
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Phone Number:
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 Please use numbers only.
Fax Number:
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Organization Name:
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Mailing Address:
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Email Address:
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Event Information
Type of Event:
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Date of Event: (*)
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Location/Address of Event: (*)
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Available Phone Number:
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 How can we reach you at the day of the event?
Starting Time of Lecture: (*)
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Ending Time of Lecture:
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Description of the Audience:
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 Students, group members, general public, etc.
Expected Attendance:
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 Please use numbers only.

Topic and Speaker
Requested Speaker(s):



















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Requested Topic(s):
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Publicity
Advertising Used:
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 Invitations, newsletters, newspaper, etc. Please provide copies
Information to Post on Consulate Site: (*)


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Extra Notes:
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Please verify: Please verify:
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