requestform

Thank you for your interest in having Author Alquan Pinkard visit and speak with your organization. Please fill out the following form and submit it at the bottom of the page.

First Name

required

Last Name

required

Address

required

Address line 2

City

required

State

required

Phone

required

Fax

Email

required

Name of Group / Book Club / Organization

required

Requested Date of Visit

required

Number of Participants

required

Age Group

required

Number of Books Requested

required

Private or Public event?

Public Private

required

Will There Be Other Speakers?

Yes No

Please tell us why you would like Author Alquan Pinkard to speak with your group?

Comments, Questions, Special Requests