VIRTUAL SPEAKER INVITATION FORM Date *Sponsor *(Provide the name of host organization, street address, city state, zip code)Speaker *How did you hear about the speaker?Event Date(s) *Event Description *(Type: Lecture, Panel, Virtual Book Signing ,Reading,Conversation/Interview. Include full schedule and times) Event Time(s) (including time zone) *Event Platform (What online technology system will you be using?) *Instructions for Event Platform *Honorarium *Topic *Audience Profile *Number of Expected Attendees *Public Event *YES NOVirtual Book Signing *YESNOAnticipated Book Sales If ApplicableSpeaker Attire (mark one): *CasualBusiness CasualBusinessAcademic RegaliaSponsor Contact InformationSponsor Contact Name *Title *Business Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone Number *Email *Signature Name and Title of Individual Responsible for Signing Contract *If Speaker accepts this offer, a binding contract will subsequently be formed. THIS IS NOT A CONTRACT. *Signature DateMessageSubmit