Starrific Speaking Booking Form
Please fill out the form competely and allow up to 2 business days for a response.
Name
*
First Name
Last Name
Event Title
*
Event Date/Time
*
-
Day
-
Month
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Event Description
*
Event Admission Fee? If so, how much?
*
Format: (000) 000-0000.
Host Organization/Company
*
Describe Organization/Company Mission and Vision
*
Event Coordinator
*
First Name
Last Name
Event Coordinator Number & Email
*
Describe your type of host organization/company?
*
Corporation/ Govermental Agency
Church or Ministry
College or School
Non-Profit Organization
Private Event
Other
How will the event take place?
*
In Person
Virtual/ Livestream
What services is requested of Dr. Starr?
*
Keynote Speaker
Workshop Facilitator
Training
Host
Panelist
Interview
Time Dr. Starr is Expected to Arrive
*
-
Day
-
Month
Year
Date
Hour Minutes
AM
PM
AM/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.
Submit
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