Please provide as much of the following information as possible to ensure that your request is met to your complete satisfaction.

Organization Information
Name of Organization:
Street Address:
City, Zip:
Office Phone:
Fax:
Website Address:
Contact Information
Contact Person & Title::
Street Address:
City, Zip:
Office Phone:
Fax:
Email Address:
Event Information - What date and time would you like to book the speaker for your event?
1st choice Date and Time:
2nd Choice Date and Time:
Event Location Name:
Event Location Address:
Event Location Phone:
Presentation Time:
Presentation Length:
Number of Attendees:
Number of Members:

Topics of Interest	Type of Presentation
Indor and Outdoor Water Conservation   General Water Conservation Education   Smart Irrigation   Rebates/Incentives   Ordinance/Regulations	PowerPoint   Lecture   Panel Participating   Ordinance/Regulations   Event Location Name
What equipment will your facility provide?
Laptop   Screen   Overhead Project	PowerPoint projector   TV/VCR   N/A - Lecture Only

Additional Comments: