Book Engagement

    Contact and Organization Information

    Sponsoring Organization

    Contact Name

    Contact Position

    Contact Phone/Fax #

    Contact Email

    Contact Address

    Organization's Mission

    Is organization a 501 (c)(3)


    Relationship with Dept of VA

    Website URL

    Audience Composition

    Audience Expected

    Is this program solely for Veterans?


    What type of Veteran program

    What level of life experiences?

    Will this event be videotaped?


    Written Materials/Biography

    Due Date for Materials/Biography

    Contact info to send material

    Please Describe Your Program

    Date of Program

    Time of Program

    Location of Program

    Name of Program

    What is the Theme/Purpose

    Requested Speaker (if you are interested in a particular speaker)

    Proposed Topic(s)

    Time of Speaker's Presentation

    Length of Presentation

    Presentation Format