Speaker Request Form
Magdalene's, Inc.
Group / Organization Name
*
Group / Organization Type:
*
Civic
Church
School
Other
Number of Members in Group / Organization Expected to be in Attendance
*
Date and Time of Event
*
Duration of Event (1 hour, 2 hours, etc.)
*
Time Allotted for Presentation by Magdalene's Speaker
*
Will there be an opportunity for Q&A?
*
Yes
No
How much time will be allotted for Q&A?
*
Address of Event
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Available Media
*
Smart Television
Power Point Projection
Other
Magdalene's sells its popular blessing rings, various survivor crafted products and other products, all of which support its mission. Is it possible to include a small retail opportunity as a part of our presence or speaking at your event?
*
Yes
No
Need more information
Contact Person
*
First Name
Last Name
Email
*
example@example.com
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
Should be Empty: