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Speaker
*
Name of your organization
*
Address of your organization
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Date of speaking engagement
*
-
Month
-
Day
Year
Date
Time zone
Platform* (Zoom, WebEx, ON24, Google Hangout, etc.)
*NOTE: Sponsor is responsible for hosting the platform of their choosing
Name of Conference
Major Objective
Theme
Attire
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Specific Objectives For This Speaker's Presentation
Name & Title of The Introducer
Name of last year's speaker
Exact schedule of events for the speaker (include times please)
Audience demographics:
Size of audience
Average age
% Men
% Women
General Description of Attendees
If this speaker could leave your group with two thoughts, what would they be?
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Speaker's contact prior to meeting
Name
First Name
Last Name
Title
Office Phone
Please enter a valid phone number.
Cell Phone
Email
*
example@example.com
Speaker's contact day of meeting
Name
First Name
Last Name
Title
Office Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Email
*
example@example.com
Event Social Media
Which social media accounts will you use for this event?
Please list any social media username, including platform, that may be used for this event. [For example, we are @aeispeakers on Twitter, Instagram and Facebook.]
Event Hashtag?
Book Signing
Please contact Melissa Fiorillo at melissa@aeispeakers.com or 617-782-3111 to discuss options for ordering, shipping, quantity and pricing for your book signing. Book orders should be arranged no less than 30 days prior to the event.
Any other information that the speaker should be aware of?
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