Speaker Appearance Request Form

Event Date:
Name of Host Group/Organization:
Contact Name:
Contact Phone:
Billing Address:
City:
State:	Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Postal Code/Zip:
Contact E-Mail:
Event Location Address:
Phone at Event Location:
Estimated Attendance:
Event Time:
Requested Topic:

Flight/Transportation Arrangements

We would like to make the flight arrangements to and from Please make the flight arrangements and invoice us Speakers does not drive (check if speaker does not drive) Someone will be picking speakers up: from airport to event from event to hotel to airport Speakers should take taxis / shuttles to locations

Accommodations

Marriott, Crowne Plaza, Sheraton, Westin or Hilton is preferred. Motels are not acceptable. Independently owned hotels and bed & breakfasts must be cleared with speaker first. Host group is to reserve room and expenses on their credit card before check-ins.
(Please do not reserve room until confirmation is received from Williams Floyd and Moore.)

Publication Distribution

Copies of People of Colour Illustrations: Klip~Klik Art to be distributed at event.

Name of local bookstore:
Bookstore Phone:
Name of local newspaper:
Newspaper Phone:
Name of Local Radio Station:
Local Radio Station Phone:
Signature of Authorizing Officer (if printed):
Date:

A confirmation of event appearance will follow. Please make no reservations/promotion efforts until this confirmation is received.
Please contact S2Tspeaks at the numbers below if any information changes before the event.
Email or Mail complete form to:
Williams Floyd and Moore 3025 Lytle Drive Nashville, TN 37218
phone: 615.299.9906 E-mail twinataa@twinataa.com