Speaking Form Organization Name * Organization Website http:// Contact / Name * First Name Last Name Email * Dates of Event * Nearest Major Airport and Distance from Event * Where is the Location of the Event? * City, province/state, or virtual event Tell Me About your Event or Gathering * Please describe the purpose, theme, and / or topic of your event. Attendees * Anticipated number and description of audience/season of life Speaking Sessions * How many sessions & length of each session Budgeted Honorarium * (Please note this is separate from travel and lodging, for which the host is responsible) Any other details you’d like us to know? Thank you!