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April 26, 2017  
Appearance/Interview Request Form

If you would like Dr. Wigand to appear at your school or event or would like to request an interview, please fill out the appearance request form below.

Please note: All requests must be submitted a minimum of 60 days prior to the event.

Name of school or organization requesting the appearance or interview:
Type of request:
Name of event (if applicable):
Location of event including city/state (if applicable):
Description of event or subject of interview (if applicable):
Number of people attending event or conducting interview:  
Requested date(s) of appearance or interview:
Contact person:
Contact phone number:
Contact email:
 I have read and agree to the terms and conditions for booking Dr. Wigand
  
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