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Contact Information
Full Name*
E-mail address*
MVCR Instructor* Yes No (If yes, skip to Meeting Information)
Job Title**
Institution**
Department**
Mailing Address**
City**
State**
Zip Code**
Phone** xxx-xxx-xxxx
 
Meeting Information
Type of Meeting * Classroom Meeting Training & Development
Elluminate Practice for Moderator(s)
   
# of Participants * (Estimate the maximum number of participants)
Length* (Estimate time in minutes)
# of Sessions *
   
Purpose/Overview*
 
Posssible Meeting Dates/Times

If you indicated above that you are offering more than one session, please put the session information below. If you are holding only one session of your meeting, please provide at least 3 possible dates and times - order based on preference. Thanks!

Date 1 * (mm/dd/yyyy) Date 2 (mm/dd/yyyy)
Start Time * am pm Start Time am pm
End Time * am pm End Time am pm
 
Date 3 (mm/dd/yyyy) Date 4 (mm/dd/yyyy)
Start Time am pm Start Time am pm
End Time am pm End Time am pm
 

* = required fields
** = required fields if not an MVCR Instructor

  

 

 

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