Reconciliation Dialogue Workshops

Date of Event

Name of Event

Requesting Organization

Type of Request
Conference/Event Keynote AddressSpeech/Public TalkPanel DiscussionReconciliation Dialogue WorkshopLunch and Learn Session

Contact Name

Contact Phone

Contact Email

Requested Time for Engagement

Event Location Address

Street Address

Apt, Suite, Bldg. (optional)

City

State / Province / Region

Postal / Zip Code

Country

Potential Audience Size (please specify number)

Audience Type (Political Figures, Indigenous Leaders, Community Leaders, etc.)

Event Description

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