Would you like to have Dr. Bird speak to your group?
Name
Phone Number
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Email Address
Dates you are interested in having Dr. Bird speak?
please pick 2 or 3 choices
First Date Preference
Pick your optimal date
Second Date Preference
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Third Date preference
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Check all that apply
Keynote
Workshop
Full Day Conference
Staff Development Day
Assembly
How can Dr. Bird help you?
Who is your audience and what are your goals?