Starrific Speaking Booking Form

Starrific Speaking Booking Form

Please fill out the form competely and allow up to 2 business days for a response.
Event Title *
example@example.com
Event Date/Time *

Day Month Year
Date
Hour Minutes AM/PM Option
Event Description *
Event Admission Fee? If so, how much? *
Host Organization/Company *
example@example.com
Describe Organization/Company Mission and Vision *
Event Coordinator *

First Name Last Name
Event Coordinator Number & Email Address *
example@example.com
Where will the event take place?

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 Option
Please describe the audience, estimated attendance, how long speaking is expected and topics to be addressed. *
What is your approved budget to hire Dr. Starr as a speaker? * Hotel and travel accomodations are required if event is outside of a 50 mile radius from metro Atlanta, GA. *
example@example.com
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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