Name of organization making request:

Contact person(s):
 

E-mail Address:

Phone:

         Mailing Address:
                                     

Dates for Rally/Conference/Event:

Please provide as much of the following information as you have available at this time:

(1) A general description of event. 
(2) An explanation of the role you are requesting Carmen to   
fill (example: key-note speaker, concurrent session speaker). 
(3) The number of sessions you wish Carmen to give (and length of time for each session).
(4) A description of the audience(s) to which Carmen will make her address (example: families, parents, youth — what ages, faith background or secular setting).