Book Melody to Speak - Inquiry Form
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Organization Name
*
Website
*
Social Media Link
Contact Person
*
First Name
Last Name
Your Role/Title
E-mail
*
Phone Number
-
Area Code
Phone Number
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Theme of Your Event
Type of Event
*
Conference
Virtual Summit
Corporation
School
Church
Non-Profit
Blog
Podcast
Radio
Television
Magazine
Commercial/Ad
Other
Event Location: City, State, Venue or Website (for virtual events)
*
Please describe your event
*
What would you like to book Melody to do at your event?
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Keynote Speech
Breakout Session
Workshop/Training
Interview
Panel Discussion
Moderator
Host
Brand Ambassador
Other
What topic(s) would you like Melody to address?
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Date of Event
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/
Month
/
Day
Year
Date
Time Melody would speak
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Hour
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05
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55
Minute
AM
PM
AM/PM Option
Until
until
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Hour
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Minute
AM
PM
AM/PM Option
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Page 3 of 4
Please describe your audience
*
What is the estimated size of the audience for this event?
*
Please describe why Melody would be a good fit for your audience and event
*
Will this event be recorded?
*
Yes
No
Will this event be live or a replay?
*
Live
A Replay
Both
How will this speech be used? (put up for sale, published on your website, etc.)
*
Does Melody receive a copy of the recording and transcript to use? *
Yes
No
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Page 4 of 4
What is your speaker budget for this event?
*
$0 - Free Event
$500-$1,500
$1,500-$3,000
$3,000-$5,000
$5,000-$10,000
$10,000-$25,000
$25,000-$50,000
$50,000-$100,000
Over $100,000
Is travel and lodging included (from Dallas, TX) for Melody and her assistant?
*
Will ground transportation and meals be provided?
*
How will you promote this event?
*
Do you have an affiliate program to promote this event? If yes, feel free to include sign up details.
Additional questions or comments:
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