Starrific Speaking Booking Form

Name*

First NameLast Name

Event Title *

Event Date/Time*

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?*

How will the event take place?*

In PersonVirtual/ Livestream

What services is requested of Dr. Starr?*

Time Dr. Starr is Expected to Arrive*

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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