Event Speaker Request Form Host Organization: Website of Organization: Proposed Dates & Times: Contact Person Information Contact Name* (first,last): Contact Email*: Contact Phone*: Contact Mailing Address: Event Info Name/Title of Event: Theme of Event: Preferred topic: As a speaker, what need can Bob fill for your event?: Time required (Include speaking and autographing books): Estimated number of people attending: Location (Include venue, street address, city & phone): If necessary, can organization provide assistance with book sales?: Driving directions form major highway: Please enter the the following code into the box: