Diseases Speaker: Tim Durham ID: 36: Topic: Diseases: Location: Ferrum Speaker Request Please complete this form to submit a speaker request. The speaker will contact you to arrange mutually satisfactory arrangements (if at all possible). Your Name* First Last Your Phone*Your Email* Your MG Unit* Your position in the unit* Speaker requested:* Topic Requested* Event*MG members meetingCommunity outreach eventVMGA eventOtherOther If "Other", please describe including estimated attendancePreferred Date* MM slash DD slash YYYY Alternate Date* MM slash DD slash YYYY
