Name of Event: Date and Time of Event: Location: Sponsored by: Sponsor’s Address/City/State: Phone: Host Organization’s Website: Contact's Name: Phone: Email: Theme/Subject of my presentation: How many times will I speak and for how long? Please note: The cost you were quoted was based upon these guidelines: Brunch/luncheon: 1 session One-day retreat: 2 sessions Weekend retreat: 3 or 4 sessions If you require more sessions, please speak with me before filling out the online form. Thanks! I will be using a PowerPoint presentation. Will a projector/screen or large TV be available? yesno Please indicate what multimedia will be provided. (projector, sound, etc.) When shall I arrive? Depart? Overnights provided on (dates): (Private room, please.) Breakfasts on (dates): Lunches on (dates): Suppers on (dates): Anticipated Number in Attendance: Is this women only, or women & men? Women OnlyWomen and Men General description of group (age, denomination, etc.) & any other pertinent information Photo can be taken off website. Would you also like for a jpg to be emailed to you for promotion materials? NoYes Speaking Honorarium agreed upon: $ (please include amount so that we both can plan ahead) Please send me any promotional materials and the schedule for the event so that I may become familiar with you prior to arrival. (Last year’s brochure of the same event would also be helpful.) Either upload from computer: and/or link: Your name: Your email: Thanks for remembering me in your prayers! Kristi Δ