The
Judge Mathis Show
Request For Speaking Engagement Event Form
Date____________________________ and Time___________________________________
of Event:
Where will the
event take Place?
Venue Name:_______________________________________________
Address: __________________________________________________
City________________________State:
_________________________.Time:________
Contact Person:
Name_________________________________________
Phone____________________________
What is the purpose
of your event?____________________________________________________
Is the event
for a nonprofit agency or profit agency? ________________
Is this a paid
speaking engagement/event?___________
What is the amount
of the honorarium your organization will pay the Judge to speak? _________________
Please attach
any additional information about your event (invitation, flyer, brochure,
etc.)
Please complete
form and mail to:
Judge
Mathis Empowerment Network
19300
Greenfield
Detroit,
MI 48235
Should you have
any questions or require any additional information, please phone me
at: (313) 864-8813\
Sincerely,
Verdant Johnson
Special Projects
Coordinator