Dr. J and Lady J SPEAKING REQUEST QUESTIONNAIRE

Dr. J and Lady J SPEAKING REQUEST QUESTIONNAIRE

Thank you for considering Dr. J, The Counselor to speak at your event! Let's start the conversation.
Contact name*

First NameLast Name
Contact Email*
example@example.com
Contact Phone Number*

Area CodePhone Number
Name of Your Organization*
How did you hear about Dr. J The Counselor?*
Name of your event*
Describe the event you wish Dr. J to participate in*
How many attendees do you expect for your event?*
How many times do you need Dr. J to speak at your event?*
How many speakers are at your event?*
Is there a speaker fee or honorarium?*
Speaking Date(s)*
Speaking Time(s)*
How long will Dr. J be speaking for and what is the topic? *
Who will formally introduce Dr. J from his bio? *
Are there any parties that need to be acknowledged for the event in Dr. J's introduction?*
Thank you for filling out this speaking engagement questionairre. We will review your information and get in contact with you soon!
Should be Empty: