Host Organization:
Website of Organization:
Proposed Dates & Times:
Contact Name* (first,last):
Contact Email*:
Contact Phone*:
Contact Mailing Address:
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:
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