Women Talk Our Stories. Our Truth.

First Name:

Last Name:

Phone:

Email:

Mailing Address:

City:

Province/State:

Postal Code/Zip Code:

Website Address:

Do you have an email data base and if so how many contacts do you have?

Which Speaker Package are you interested in?

GOLD SPONSORSHIP ($7,000) *only one

SPEAKER PREMIUM PACKAGE ($998)

SPEAKER PACKAGE ($798)

90-MINUTE WORKSHOP ($997)

TABLE VENDOR ($697)

CHAIR DROP-OFF ($159)

TABLE SPONSOR (259)

What is your offer?

Have you spoken on stage before?

YES

NO

If yes, what stage were you on and what was the size of the audience?