Speaking Engagement Form

Community Location

Event Date/Time

Type of Event (i.e. luncheon, conference, board retreat, Shabbat weekend retreat)

Audience (i.e. business, women only, young leadership, lawyers)

Contact Name (required)

Contact Phone (required)

Contact Email (required)

Topic of Event

Expected Attendance

Speech Length

Available Budget for Speaker Honorariaum

(Please note that the cost of travel to and from the community, meals and lodging will be the responsibility of the community in addition to Speaker Honorarium.)