Pleae print, fill out the form and send it to the address below. Thank you.

HEALING ARTS FEST - Speakers Form

First Name:
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Last Name:
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Address:
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City:
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State:
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ZIP:
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Daytime Phone:
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Evening Phone:
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E-mail:
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Title of Workshop:
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Brief Description of Topic:
(Program; 30 words)
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CHOICE OF TIME SLOT:
 Please indicate your preferred speaking time by numbering 1-7 below. 1 being first choice and 7 being last choice. Every effort will be made to accommodate your preference.

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11:00 - 11:45
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12:00 - 12:45
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1:00 - 1:45
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2:00 - 2:45
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3:00 - 3:45
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4:00 - 4:45
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5:00 - 5:45

  Your bio will be in the Healing Arts Fest Resource Guide via insert if received by June 27,2001 and via insert if received after June 27, and before August 3, 2001. No listings after August 3, 2001 will be accepted.
Short Speaker Bio (15 words)

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Please send the completed form to: Hudson Valley Healing Arts Fest 2001, 180 Wittenberg Road, Bearsville NY 12406 Tel: 845.679.4293