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* = Required Field |
| Event name: |
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| Organization hosting event: |
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| Contact information: |
| Name of key contact individual: * |
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| Address: |
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| City: |
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| State: |
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| Zip: |
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| Phone: |
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| Fax: |
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| Email: * |
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| Date and time of desired appearance: |
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| Location of appearance (city, state, venue): |
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| Nature of appearance (keynote speech, debate, panel, etc.), desired subject matter, and expected duration: |
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| Will CLE credit be offered to attendees? |
Yes
No |
| Are written materials required? If so, by what date? |
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| If other speakers are involved, please list those confirmed: |
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| Other potential speakers being contacted: |
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| Description of event and audience (number of attendees anticipated; are they law students, practicing attorneys, business group, etc.): |
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| Will members of the news media be present? |
Yes
No |
| Will the event be videotaped or recorded? |
Yes No |
| Is the event open to the public? |
Yes No |
| Is there an admission charge? |
Yes No |
| Organizers will pay speaker's (please check those applicable): |
local expenses
air travel
hotel and meals
honorarium of $ |
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| Enter the text above: |
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