Retreat Speaker Request

RETREAT SPEAKER FORM
Host Organization *
Proposed Dates & Times *
*CONTACT PERSON INFORMATION*
Contact Name (first,last) *
Contact Email *
Contact Phone: *
Contact Mailing Address: *
*RETREAT INFORMATION*
Name/Title of Retreat *
Theme of Retreat: *
Preferred Topics: *
Location (Include venue, street address, city & phone # *
Attendees: *	Women ONLY Men and Women
Presentation Times (For example -- Friday eve; Sat. Noon & Sat. Eve; Sun AM) *
Retreat Closing Time: *
Time Required (Include speaking and autographing books) *
Book Supply *	Organization will provide and sell Jane's books. Jane should bring her own supply of books.
Please provide driving directions from a major highway. *
*FEES & EXPENSES*
Usual honorarium begins at $1,500, plus travel expense and mileage.
Jane’s prayer partner and assistant, Carol, usually travels with her to regionally scheduled retreats. They are willing to share a room. The retreat committee is expected to provide registration, room and meals for Carol.
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