Speaker/Program Form
Please fill out ALL the information below so we can have an accurate description of the upcoming presentation or workshop.


Date of Presentation:
State/Province: Zip:

Speaker Name:

Title of Presentation:
Description of Presentation:
Speaker Bio & Credentials:

Cost & Lunch or Dinner info:

Speaker's Website:
Any additional Information:

Also send via email a Headshot of the speaker, any support photos or flyers, and any sponsor logos to: judi@palimorstudios.com


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