| Name of Organization: |
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| Event and Location: |
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| Requested speaking date(s): |
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| Target audience: |
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| Expected Attendance: |
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| Purpose of Event: |
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| Event Budget for Speaker: |
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| Names of other special guests: |
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Describe exactly what you are requesting of Deborah, i.e., Keynote speaker, Special Seminar #1 or #2, workshop leader, event moderator, # of presentations:
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Please give us a brief history of this event, i.e., previous speakers, past attendance, annual (if so, how many years):
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Background information on the inviting organization:
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| Organization phone number: |
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| Organization website: |
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| Your name |
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| What is your role with planning the event? |
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| Your e-mail address: |
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| Your phone number: |
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| Best time to contact: |
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| Will Deborah be able to sell her books, tapes, CDs, and products at your event? |
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COMMENTS:
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