Doctor Speaker Request Details in Cypress, TX

Email Address*

**Will CFAH products be purchased by the sponsoring organization?

**Will this engagement be videotaped and a copy provided to CFAH?

Logistics

Indicate any special needs your organization may have

(To be covered by sponsoring organization prior to the event)

What is mileage from Cypress, TX?

(Air travel to be secured/covered by the organization; preferences, i.e. airline, frequent flyer #, seat, flight times, etc. will be provided)

What is the length of travel time from airport to meeting place?

(To be secured/covered by organization sponsoring this event)

Please provide details of the Person Picking Up the Speaker, Car Service or Rental

(To be secured/covered by the organization; queen or king-sized bed, non-smoking room, and high floor preferred)

Hotel Name

Hotel Address

Street Address Address Line 2 City State ZIP Code

Hotel Website

Name

This field is for validation purposes and should be left unchanged.