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Name of Organization
Event and Location
Speaking Dates
Target Audience
Describe exactly what you are requesting of Candace, i.e., Keynote speaker, Special Seminar #1 or #2, workshop leader, event moderator, # of presentations:
Please give us a brief history of this event, i.e., previous speakers, past attendance, annual (if so, how many years):
Organization Web Address
Your Name:
What is your role with plannning the event?
Your Email Address:
Your Phone Number
Will Candace be able to sell her books, tapes, and products at your event? Yes
No
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