Program Proposal Form

*Name:


*Address:


*Phone:


*Email:


Website:


*Program Title:


*Program Description:


*Intended audience:
Children Teens Adults Seniors

Have you presented here before? If so, when and on what topic?


*How long is your program?
30 - 45 minutes 45 - 60 minutes 1 hour - 1.5 hours 1.5 hours - 2 hours

*What is your proposed cost? Is this fee negotiable?


Briefly describe where have you presented in the past. Include the date presented and topics.


Leave this empty: