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.)