CBW-LA SPEAKER FORM
Please fill out the form below to help us set up your registration page.
Name
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E-mail
*
Phone Number
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Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Legal Name (if different from author name-this is what we will use on the check)
Author Website
Other Social Media Sites (put N/A if none)
Author Bio
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Author Photo
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of
Book Title
*
Book Summary
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Book Cover
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of
Link to Buy Book
Book Price
*
Proposed Workshop Date
*
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Month
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Day
Year
Date
Title of Proposed Workshop
*
Description of Proposed Workshop
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Additional Proposed Workshops
If you have other workshop proposals, please fill out the form below
2nd Workshop Title
2nd Workshop Description
3rd Workshop Title
3rd Workshop Description
4th Book Title
4th Workshop Description
5th Workshop Title
5th Workshop Description
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