Eva Paterson Speaking Request

Organization and Website Address
Contact Title
Name
Address
City and State
ZIP
E-mail
Phone Number (no hyphens)
Fax Number (no hyphens)
Event Title or Name
Date of Event (MM/DD/YYYY)
Time of Event (HH:MM AM or PM)
Event Location and Address
Time of Remarks (HH:MM AM or PM)
Speech Topic
Type and Length of Remarks
Please provide additional details about the topic, i.e. what would you like Eva to cover?
Additional Topic Details
Audience Profile
Audience Size Expected
Speaker Setup
Honorarium Provided?





Attire





Deadline to RSVP to You (MM/DD/YYYY)
Should Eva not be available, please indicate below if you are open to us proposing another speaker from our organization, such as a board member or another member of our staff.
Alternate EJS Speaker Acceptable