Bookstore Speaker Request

BOOKSTORE SPEAKER REQUEST
Host Bookstore *
Proposed Dates & Times *
CONTACT PERSON INFORMATION
Contact Name (first,last) *
Contact Email *
Contact Phone: *
Contact Mailing Address: *
Organization's Website: *
*EVENT INFORMATION*
Type of Event (Luncheon, book signing, etc.)
Event Theme:
Preferred Topics (or book you'd like Jane to focus on): *
Location (Include venue, street address, city & phone # *
Time Required (Include speaking and autographing books) Jane likes to have 30 minutes to present prior to signing. *
*SEATING & EXPECTED ATTENDANCE*
Anticipated Attendance: *
Seating Capcity of your store: *
Sometimes other sites, such as restaurants, are used in cooperation with bookstores for Jane's events.
If your store is small, is another cooperative venue possible?	Yes No Uncertain
*EVENT PROMOTION*
Have you been in contact with Lynette Kittle at WaterBrook Multnomah Publishing Group / Random House (lkittle@randomhouse.com) about this event and related promotional materials? *	Yes. No.
What kind of publicity will be done to promote this event? *
Check all that apply:	The event will be open to the public. A fee will be charged.
* The above question typically refers to a situation when a meal is planned or if Jane is speaking at a different location and your store is providing the books for sale.
DRIVING DIRECTIONS FROM MAJOR HIGHWAY *
*FEES & EXPENSES*
What amount does your group usually budget for a speaker presentation? *
Check all that apply:	We will reimburse mileage. We will reimburse travel expenses.
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