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: