Request Deborah

Name of Organization *

Event Title and Location (City / State): *

Requested Speaking Date (s): *

Target Audience: *

Expected Attendance: *

Purpose of Event: *

Event Budget for Speaker: *

Names of Other Special Guests: *

Describe exactly what you are requesting of Deborah (keynote message, seminar/workshop leader (# of presentations), moderator, etc.): *

Please give us a brief history of this event, i.e., previous speakers, past attendance, annual (if so, how many years): *

Background information on your organization:

Organization phone number

Organization website:

Your name *

What is your role with planning the event? *

Your phone number *

Your e-mail address: *

Will Deborah be able to sell her books, tapes, CDs, and products at your event? *

COMMENTS:

Phone