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