Book A Speaker Form

As you are aware, there are many details that go into booking a speaker so please understand that this booking form serves as an invitation only. This does not constitute a confirmation of speaker appearance or acceptance. It will assist us in making the best decision possible while doing all that we can to meet your request. Thank you!

Full Name*

First NameLast Name

E-mail*

Phone Number*

Area CodePhone Number

Event Date/Start Time*

DayMonthYearHourMinutesAM/PM Option

Event End Date/End Time*

DayMonthYearHourMinutesAM/PM Option

Event Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Purpose of event / About the event*

Select Speaker*

Speaker Topic(s)/Message*

Role of the speaker and speaking expectations*

Timeline and itinerary (include arrival and departure times)*

Multiple Presentations Needed?*

Yes or No

Audience Size*

Describe the audience. What do they do? What are their challenges? What do they want to learn/take away from this session?*

A/V equipment available?*

YesNoN/A

Will any portion of this event be recorded, broadcast, or streamed? (If so, describe)*

Internet access available?*

Vendor table available for book/product sales?*

Interested in purchasing books/audio or other material for audience?*

What is your budget for this presentation/performance?*

Speaker/Performer Fee

What are the guidelines for travel budget and arrangements? *

Onsite event contact name and cell phone number?*

If your request is approved a 50% deposit along with a signed contract is required in order to finalize arrangements for a speaking/performance engagement. The remaining balance will be due 24 hours before the event.

Additional Message:

Please verify that you are human*