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
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
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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