Full Name *
Email *
Why host Simran? *
What Region are you located in? *
If OTHER, what region and date would you like to host Simran?
Possible dates for the event you would like to host: *
Expected number of people at the event: *
Venue you have in mind for the event: *
Physical Address (Street, State, Country) *
Contact Phone *
Are you willing to cover transportation costs and provide lodging? *
Do you have a budget or stipend being offered to have Simran speak? *
How did you hear about Simran? *
Additional Comments:
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