Dorothy Burton Speaking Request

* Organization Name

* Contact Name

* Contact Phone

* Contact Email

* Contact Address

* Organization Website

* Event Name

* Event Location

* Event Date

* Brief Description of Event

* Number of Guests Expected

* Who is the target audience?

* Is your event:

* How long would you like Dorothy to speak?

* Additional speakers at the event

* Is there a topic you would like Dorothy to address?

* Will event be recorded?

* Are airfare, mileage, lodging and meals included?

* Are you able to cover travel expenses for an assistant?

* Is an honorarium provided?

* Will you provide a master-quality, digital audio and video recording (if applicable) of Dorothy's presentation to use at her discretion?

* Are there any other additional requests associated with event?

Social Commitments Interviews Meetings Meet and Greet Other None

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