Starrific Speaking Booking Form

Starrific Speaking Booking Form

Please fill out the form competely and allow up to 2 business days for a response.
Name*

First NameLast Name
Event Title *
Event Date/Time*

DayMonthYear
Date
Hour MinutesAM/PM Option
Event Description*
Event Admission Fee? If so, how much? *
Host Organization/Company*
Describe Organization/Company Mission and Vision*
Event Coordinator*

First NameLast Name
Event Coordinator Number & Email*
Describe your type of host organization/company?*

Corporation/ Govermental AgencyChurch or MinistryCollege or SchoolNon-Profit OrganizationPrivate EventOther
How will the event take place?*

In PersonVirtual/ Livestream
What services is requested of Dr. Starr?*

Keynote SpeakerWorkshop FacilitatorTrainingHostPanelistInterview
Time Dr. Starr is Expected to Arrive*

DayMonthYear
Date
Hour MinutesAM/PM Option
Please describe the audience, estimated attendance, how long speaking is expected and topics to be addressed.*
What is the budget approved budget to hire Dr. Starr for speaking engagement?*
Additional Comments:
Signature - Please note this is only a request form to book Dr. Starr to speak. Final approval will be determined within the alloted time.

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