D. Seles Booking
Organization Name *
Organization Number *
Organization Email Address *
Organization URL *
If there's no url, type N/A
Organization Address: *
EX: 123 CHERRY STREET
Organization City, State & Zip Code *
EX: Atlanta, GA 36748
Main Contact First Name: *
Main Contact Last Name: *
Main Contact Number *
Main Contact Email *
Date of the Event *
MM
/
DD
/
YYYY
Time of the Event: *
Time
:
Estimated time for presentation: *
Time
:
How long is the presentation: *
Ex: Set will be 30mins
Is there a specific theme: *
If yes, please list details below. If no, please type: N/Ax
Will you need photos of for promotions? *
If yes, a photo will be emailed to you for promotions. We ask that no photo be pulled from any social media accounts.
Speaker budget *
Additional Information *
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