Speaker Request: Tara Peterson | YWCA Glendale & Pasadena

Speaker Request Form for Tara Peterson

Primary Contact

Name Title

Work Phone

Cell Phone

Name of Organization:

Is the organization for profit/not for profit?

Name of the Event:

Event Location:

Street Address City State ZIP Code

Date and Time of the Event:

Event Type:

Breakfast, dinner, gala, conference, small group, etc.

Type of Appearance Requested:

Speech, presentation, panel, interview, etc.

Length of Appearance and/or Speaking Request:

Requested Topic:

What information or materials will you require in advance of the appearance?

Speech, bio, headshot, etc.

Who is the audience for this event?

Will media be invited? If so, will the event be open or closed press? Please submit a media list if applicable.

Will you be providing an honorarium for this appearance? If yes, please indicate the amount.

If applicable, will travel costs/reimbursement be provided for this event? If so, please describe.

Cost of Event Attendance: