Speaking Engagement Request Form David Agron, Ph.D. [email protected] | [email protected] (626) 617-0527 | (800) 251-0255 Date of Request* Date of Function* Organization* Contact Name* Email* Phone* Function Theme/Topic Location Audience (size, age range, etc.) Number/length of messages Function Schedule Time Dr. Agron will speak Dress code Book Sales Table ApprovedDenied Will function be recorded? NoYes (audio)Yes (video) If Dr. Agron's material is recorded, • Dr. Agron grants permission for your internal use and distribution (e.g., copies given or sold to church members but not sold online or at other venues) • Dr. Agron must receive a copy that can be reproduced and use with full rights Compensation Accommodations Meals Transportation Method/Time of payment Any additional information you need from Dr. Agron