Invitation Request Form


I am interested in booking:

Name of Sponsor/Organization:

Contact Person and Title:

Email Address:

Phone Number:

Fax Number:

Mailing Address:



Event Information


Proposed Date(s):

Event Description/Speaker's Theme/Speaker's role (i.e. Keynote, workshop, moderator, etc.)

Event Registration Fee (please indicate if the event is free to students):

Preliminary schedule for speaker

Estimated Number of Attendees:

Event Demographics:

Venue Location:

Speaker’s Fee Offered: (Note: you would also be responsible for all travel, food per diem & accomodation expenses)



Logistical Information


Nearest Airport to Venue:

Approximate Event Ticket Price:

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