Speakers Form

Name
Email Address *
Phone
State/province
Country
Organization/Institution
Type of Event
Issue Area	women's issues economic exploitation human rights environment other
Other Issue Area
Budget (If available)	travel expenses travel and speaker fee budget to invite speaker from Congo no budget
Proposed Date of Event
Alternate Date of Event
Is any media equipment available at the site		(e.g. vcr, projector for a power point presentation, microphone/speakers?)
Type code from image