Name/Address of Organization(required) Event Title and Location (City / State):(required) Requested Speaking Date (s):(required) Target Audience:(required) Expected Attendance(required) Purpose of Event:(required) Will Deborah be able to sell her books, tapes, CDs, and products at your event? *(required) Yes No Event Budget for Speaker: Names of Other Special Guests: Organization phone number(required) Organization Website Describe exactly what you are requesting of Deborah (keynote message, seminar/workshop leader (# of presentations), moderator, etc.): (required) 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:(required) Your name(required) What is your role with planning the event? Decision Maker, Event Planner, Committee Member,Interested Party(required) Decision Maker Event Planner Committee Member Interested Party Your phone number(required) Your e-mail address:(required) Submit