Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
What is the focus/title of your event?
Date of Event
*
-
Year
-
Month
Day
Date
What is the time of the event?
Website/Social Media Link for Organization/Event
Who is the headliner/host or organization hosting the event
*
Estimated guest/attendees count
Event Flyer/Agenda/ Itinerary
Browse Files
Cancel
of
Estimated guest/attendees count
Event Type
*
Summit
Conference
Business
Church Service/Prayer Breakfast
Book Signing
Virtual - Online Speaker
In-person event
Other
Event Type Description
Event Address/Venue
What's Your Speaker/Trainer Budget?
*
What type of talk would you like Therese to do?
*
Host/Facilitate
Breakout Session
Keynote
Trainer
Panelist
Other
Events topics of discussion
What day of the event will Therese be presenting/selling? (Therese preference is the 2nd day, prior to lunch at live events?)
Additional Speaker(s)?
Are all speakers pitching products/services? What price range?
What is the producer/speaker spilt?
When will we get paid? or do we process our own orders.
Do you have demographic/psycho-graphic profiles or details on the audience? (age, income, business types, etc.)
What is the best price/package to offer?
Have you done this event before?
Yes
No
How many attendees were there?
Event History
What expenses will you be paying (travel, hotel, class, meals, etc.)
What equipment is provided?
What equipment do you expect Therese to provide?
Are you promoting the event and to how many people?
Will Therese have additional obligations in order to participate?
Thank you for submission. A member of our management team will be in touch with you shortly.
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