Speaker Invitation Form
Thank you for your interest in booking our Speaker. We strive to provide excellent service to enhance your event. If you’ve ever heard our speaker, you know she leaves her heart and soul on the stage. Please allow 48 hours for a response.
Who are You Inviting To Speak?
*
Selika Corley-Funchess
What is the age group of your audience? Please check all that apply.
12 and under
13-18
Over 18
Other
Your Name
*
First Name
Last Name
Your Contact Email
*
example@example.com
Your Contact Phone Number
-
Area Code
Phone Number
Name of the Organization
*
Organization or Event Website
*
Name of Requested Event or Conference
*
Theme(s) and/or Focus of Gathering. Please include event colors if applicable.
Date of Event
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Expected Number of Attendees
*
Event Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How many sessions will you need a Speaker??
*
1
2
3
Will Hotel and Travel Expenses be Reimbursed?
*
Yes
No
What is your budget for a Speaker?
*
Please List The Day(s) and Time(s) You Would Like a Speaker
Will There be a Resource Table Available or needed?
*
Yes
No
Will there be a photographer or videographer for the event?
*
Yes
No
Additional Relevant Information or Requests
Submit
Should be Empty: