I wish to book: *

Dr. Shanta Premawardhana

Ms. Soraya Deen

Rev. Abare Kallah

Bishop Illangasinghe

Your Name (as primary contact) *

First Name

Last Name

Your Phone *

(###)

###

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What Format:

Lecture

Roundtable

Interactive Discussion

Presentation (banquet, etc.)

Other

Allow for Q&A?

Yes

No

Deadline for Acceptance *

MM

DD

YYYY