Speakers

Select a Speaker (required)
---Camille PauleyMichael PauleyLisa-Ann OliverOther

Preference is given to organizations which can meet the following honorarium amounts, payable to “Healing the Culture.”
Camille Pauley $3,000 • Michael Pauley $2,000 • Lisa-Ann Oliver $1,500
Honorarium Offered

Will you pay for travel?
 Yes No

Will you pay for lodging?
 Yes No

Will you pay for meals?
 Yes No

Is there booth space at this event?

 Yes No

Name of airport speakers will fly into (if applicable)

Event #1 (required)

Number of years held ---1234567891010+

Event Date - Time of Event

Number of attendees expected

Usual attendance

Speech time allotment

Speech topic

Type of audience/age range

Physical Address (required)





State
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Event #2 (if applicable)

Number of years held ---1234567891010+

Event Date - Time of Event

Number of attendees expected

Usual attendance

Speech time allotment

Speech topic

Type of audience/age range

Physical Address





State

_________________________________________________________________

Event #3 (if applicable)

Number of years held ---1234567891010+

Event Date - Time of Event

Number of attendees expected

Usual attendance

Speech time allotment

Speech topic

Type of audience/age range

Physical Address





State
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Organization Name

Organization Website

Organization Address (required)





State

Organization Phone Number (required)
() -

Contact Person Name (required)

Contact's Title

Contact's Email (required)

Contact's Phone Number (required)
() -

Name and Cellular of person meeting speaker at airport: