Speaker Request

So! You Want a Speaker?!
Thank you for this wonderful opportunity to work with you! Please complete this questionnaire! The time you invest in thoroughly completing this will help assure I deliver the BEST presentation possible, specialized to fit your needs!

I am looking forward to working with YOU!

Thanks!

ABOUT YOU
Full Name*

First NameLast Name
Phone*

Area CodePhone Number
E-mail*
Organization Requesting Speaker*
Your Role or Title*
Organization's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Organization's Website
Organization's Facebook Page Link
Event Page Link
Are There Any Additional Details That You Would Like to Share?

ABOUT THE VENUE
Venue Details & Location*

Venue Name

Street Address

CityState / Province

Postal / Zip CodeCountry
Venue Contact

First NameLast Name
Venue Phone Number

Area CodePhone Number
Will Coach D Nicole Be Allowed a Vending Area?*
Will a Sound System & Engineer Be Present?*
Are There Any Additional Details That You Would Like to Share?
Should be Empty: