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)
YesNo
Relationship with Dept of VA
Website URL

Audience Composition

Audience Expected
Is this program solely for Veterans?
YesNo
What type of Veteran program
What level of life experiences?
Will this event be videotaped?
YesNo

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