RatedXYZ Speaker Request Form
Full Name:
First
Last
Company:
Title:
E-mail:
Phone:
Organization:
Corporate
School/University
Non-Profit
Other
Explain Other:
Event Name:
Time/Date of Event:
Venue:
Projected Budget for Securing Services:
Are you selling tickets?
Yes
No
Will you be filming and taking photos?
Yes
No
Can products or merchandise can be sold at the event?
Yes
No
How many will attend this event?
Speaker Duration: (time)
Describe your audience and demographic.
Purpose and Theme of the Event?
Would you be interested in Coaching, Workshops, or Online Courses for your organization following the event?
Yes
No
If so, please explain.
Do you know any Organizations that would be interested in booking RatedXYZ?
Yes
No
If so, please explain.
How did hear about RatedXYZ?
Submit
Should be Empty: