Name of your organization: Current name of sponsoring organization: Date of event: Time of event: Type of event: Theme/topic for this event: Attire Activities Requested:   please select tour needs What is the exact schedule of events for this program? Specific location of event(city, state, building, room, etc.) Number of people expected to attend Contact Person's Name Title: Phone: (xxx-xxx-xxxx) Work Home Fax Pager Cell Email Please provide your organizations website address (if applicable): Closes airport Distance to event: Are you planing to audio and/or video tape the event? How will you advertise the event? Will any media outlets (radio, television, newspaper) be present at this event? If yes, which?

Motivational Speaker Minister (word of God) MC/Host Girl Power Middle School Girl Power High School Empowerment Meeting for women Empowerment Meeting Senior Women Pageant Coaching or Judging yes no yes no