Contact Information

How did you hear about Jennifer?
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Sponsoring Group

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Sponsor Organization Phone
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Cell Phone
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Home Phone
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Email

Website of Sponsoring Group or Event

Event Information

Days and Dates of Event
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DATES
20082009201020112012 YEAR

Main Theme or Goal of this Event

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Expected Size of Audience

Please give us a brief history of this event? Previous speakers, number of years in existence, past attendance, etc.  Flexible dates?

Event Location

Facility/Venue  (enter "Undecided" if not finalized at this time)


What is the name and distance of nearby cities with major airline service?

Approximate number of times Jennifer will speak

Our budget range for honorarium is approximately:
$

Our travel expense budget is approximately:
$

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