JUDGE GREG MATHIS
Speaker Request Form
Name of Event:
Organization
/ School:
Event
Date:
Alternate
Date:
Time:
Venue:
Address:
City/State:
Contact
Person:
Contact
Phone:
Contact
Email:
Event
Description:
Audience
Profile:
Include
No. of Attendees,
Age
(Youth/Adult), Industry
Type
of Presentation:
Keynote,
Panel, Luncheon,
Booksigning,
Reception
Length
of Presentation:
Honorarium Offered:
**If
you have an agenda/invitation for your event please attach a copy and include
with this form.
Questions, please call: 818/972-0615 ........................................ 818/972-7288 fax