Program Application Form

The Work of 1000 Program Application Form

Name of Course, Workshop, Seminar or Speaking Event

Sponsoring Organization

Web Site of Sponsoring Organization

Please note: If you have any other information about your sponsoring organization that you'd like to include, please send it via email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it. or by mail to 158 Heald Street, Pepperell, MA 01463.

Contact Person - Name

Phone

Mailing Address

Event Date

Event Location

Logistics: You will need a DVD player, projector, screen (10-foot wide or more works best, or a large white wall), sound system, and a mic for Marion.

Event Start and End Time

Would you like Marion and/or one of the filmmakers to speak at your event?

Marion only Filmmaker only Both

For how long would you like the speaker to be there?

Theme or main topic of the event

Audience Profile

Number of attendees expected

Deadline date for our response to you about availability

Date (today's date)

Person/Title completing this form

Enter the darker letters