Speaker

                                                      SPEAKER BOOKING FORM

 

 Name of Organization: ___________________________________________________

Address: ________________________________________City: __________________  

State: ________________________________________

Telephone: (______)_____________________________

Date of Speaking Engagement: ________________ Alternate Date:___________

Contact person: _________________________________________________________

Contact Telephone: (_____)_______________________________________________

Contact Fax Number: (_______)____________________________________________

Contract—E-mail address: ________________________________________________

Time Allocated to Speaker, not Including Question Period: _______________

Topic of Speech: _______________________________________________________

Fee:  Fill out this form and send to us or call for Speaker's Fees. Fee quotes are net and do not include travel and lodging.

E-mail this Form to:  lentonaikins@earthlink.net          Or Fax to: (661) 268-0984