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Speaker Event Report
Please submit report within 24hrs after the event
Event Name
Speaker 1 Name
Speaker 1 Organization
Speaker 2 Name
Speaker 2 Organization
Speaker 3 Name
Speaker 3 Organization
Speaker 4 Name
Speaker 4 Organization
Speaker 5 Name
Speaker 5 Organization
Other Team Members
Type of Event
*
Required
Coalition
Awareness
Law Enforcement
Healthcare
Education
Victim Care and Services
Outreach
Date of Event
Event Location Name
Address of Event Location
Total Attendance
Male Percentage
Age Group In Attenance
*
Required
Elementary
Jr. High
High School
College
18-35
35-55
55+
Total Impacted by Media
Female Percentage
Ethnicity
*
Required
White
Black
Hispanic
American Indian
Asian
Other
Total Donations Received
Wins / Highlights
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