EVENT NAME *

EVENT Date*

EVENT CITY, STATE*

EVENT VENUE*

EVENT WEBSITE

EXPECTED ATTENDANCE*

WHAT DO YOU HOPE TO ACCOMPLISH

YOUR DESIRED SPEAKING TOPICS?

PROPOSED SCHEDULE?

SPEAKERS DESIRED:
BrendaBrenda & John

ESTIMATED HONORARIUM FOR BRENDA OR FOR BRENDA AND JOHN *

TRAVEL EXPENSES FOR 2 FROM Washington DC? (SEPARATE FROM HONORARIUM) *
YESNO

CLOSEST AIRPORT *

HOSTING ORGANIZATION

HOSTING ORGANIZATION WEBSITE

CONTACT NAME *

First Name*

LAST NAME*

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CONTACT EMAIL ADDRESS *