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Thank you for your interest in suggesting or providing a program for Loudoun County Public Library. To assist your interest, please complete the following form.

Your Name:

Company Name:

Address

Phone Number:

Program Name:

Program Host Name:

Description and format of the program

Target audience and age group:

What will attendees learn from the presentation?

How many attendees will you generate through your own promotion?

How will you promote your event:

Please provide a summary of presenter qualifications:

Please list other venues where you have previously performed:

Presenters usually offer programs free to the library. If you are requesting an honorarium, please specify amount inclusive of all travel costs:

Fee Comments (optional):