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Agilistik intake
Group/Organization Name
*
Contact name
*
EMAIL
*
BEST TIME TO CONTACT
*
All times listed are in the eastern time zone.
A
Morning (9am-noon)
B
Afternoon (noon-5:30pm)
C
Evening (5:30-8:30pm)
LOCATION
*
City, State ZIP
PHONE
*
ESTIMATED NUMBER OF ATTEDEES
*
A
5-10
B
11-15
C
16-20
D
21+
E
Unknown
Type of organization
*
A
Private Business
B
Public Service (EMS/FIRE/LEO)
C
Church community
D
Social community
E
Rehabilitation and Recovery
F
School/ Education
G
Other
What are you interested in?
*
A
Stand alone presentation
B
4 week workshop for beginners
C
Emcee or Key-note engagement
D
Unsure
What would you most like Agilistik to help your group with?
*
Request Information
