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
Will you pay for travel?
Will you pay for lodging?
Will you pay for meals?
Is there booth space at this event?
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
Speech time allotment
Type of audience/age range
Physical Address (required)
Event #2 (if applicable)
Event #3 (if applicable)
Organization Address (required)
Organization Phone Number (required) () -
Contact Person Name (required)
Contact's Email (required)
Contact's Phone Number (required) () -
Name and Cellular of person meeting speaker at airport:
If you prefer, you can print out the following form and mail it in. Speaker Request Form
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© 2012 Healing the Culture | PO Box 82842, Kenmore, WA 98028 | Phone: 425-481-6563