Author Name
*
First Name
Last Name
Contact Name
*
First Name
Last Name
Contact Title
*
Contact Email
*
Contact Phone
*
(###)
###
####
Organization presenting this event
*
Organization website
Has organization hosted events in the past?
Yes
No
Unsure
Past speakers/authors hosted?
Event Location: City, State/Province, Country
*
Event date (or date options)
*
In-person or virtual appearance?
*
In-person
Virtual
Budget
*
0
Less than $5,000
$5,000-$9,999
$10,000-$20,000
$21,000-$30,000
$30,000+
Unsure
Additional budget for travel
*
Yes
No
Unsure
Speaker's obligations, format, theme (please describe):
*
Estimated audience size and makeup
*
Will there be on-site book sales; a bundled book buy; or both?
*
On-site book sales
Bundled book buy
Both
None