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Speaker Questionnaire

General Information
For tax purposes, which name should appear on the honorarium disbursments?
For tax purposes, is this a social security or tax ID number?
What form of transportation will you be taking?
Speaker Needs 
As a Guest Speaker I understand that presentation may be videotaped or recorded, for the purpose of being used and distributed for informational, educational or entertainment purposes. I give my permission and authorize the Southern Idaho District to videotape, audiotape, photograph, record, edit or otherwise reproduce my presentation.

Thanks for submitting!

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