For more information on topics, availability & fees or if you'd like to sponsor a speaking/media tour please provide more information about your event/meeting below. Today's Date: Your Name: Phone: Fax: Email Address: Name of Organization: Date of Event/Meeting: Type of Event/Meeting Breakfast Luncheon Dinner 1/2 Day Event 1 Day Event Evening Event Purpose of Event/Meeting Convention Trade Show Weekly Meeting Monthly Annual Awards Special Event Please explain more about event/meeting: Organization Address: City: State: Zip: Phone: eMail: Event/Meeting Contact Name: Program theme, you must check one: ACT as if! Eating Disorder Show Business 101 Other Topic How long is the scheduled event/meeting? (hours) May Barbara bring back-of-the room products? (DVD's, books, etc) Yes No If yes to the above question, will a table be provided? Yes No Will a lectern or microphone be provided? Yes No Will access/connections for a computer be avialable? (electrical, Internet access, projector setup) Yes No If no access/connections for a computer what audio visual equipment is available? Are printing/photo copy services provided or nearby? Yes No Number of Attendees: Average Age: How will the organization publicize the event/meeting? Does the organization have a newsletter? Yes No Check this box if meeting location is different that above: Event/Meeting Location Address: Additional info you'd like us to know about the event/meeting:
