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Dr. Farrah Gray Speaker Participation Agreement

Choose One:	Nonprofit Youth Rally/School University/College Corporation Trade Association Expo/Convention Conference Church Event

Purpose of Appearance: (choose)	Keynote with Book signing (90 minutes) Keynote Address (45-60 minutes) Question and Answer (Q&A) Session (30-45 minutes) Double_Block Booking (Negotiable) (One or session in one or two days)

Requestor/Authorized Party
Name:	Title:
Host/Sponsorships/ Institutions:
Address:
City:	State: Zip:
Phone:	Fax:
Email:
Department:
Other Contact:	Title:
Phone	Fax:


Purpose of Appearance
Program Title:
Date:	Start Time: End Time:
Location:
Venue Type:	(Hotel/Convention Center/Church etc.)
Specific Start Time:
Specific Participation:	(Select from above)
Promotional Interviews:	(Print, TV and Radio)
PLEASE NOTE: The Host/Sponsor cannot revise schedule after contract execution without the speakers written permission.
Budget Range:

Audience Type
Target Audience:
Age Group(s):
Anticipated Audience Numbers:

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