Speaker Event Form

Booking Agreement

Complete form below to retain the services of a DINAO speaker
For Direct Inquiries contact John or Renee' Strothers at Dinaowjr@gmail.com or call (757) 904-3464.
Company Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Email
example@example.com
Phone Number*

Area CodePhone Number
Company Website:
I want this speaker(s)*
Name of Event*
Nature of Booking*
Event Type*

PublicPrivateOther
Estimated Number of Guest*
Select range
Event Start Date & Time*

MonthDayYear
DateHourMinutesAM/PM Option
Event End Date & Time*

MonthDayYear
DateHourMinutesAM/PM Option
Name of Venue*
Venue Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Point of Contact*

First NameLast Name
Phone*

Area CodePhone Number
E-mail*
Honorarium Pricing

Prices based on event type and do not include travel cost. Your payment will not be processed until both parties agree on date and times.
Please select an option
prevnext( X )
Guest Speaker - solo$500.00

Hours

Joint Guest Speaker$850.00

Hours

Weekend Marriage Retreat$3,000.00

Marriage Coaching$ Free

Please Select Item

Total $0.00
Other - Negotiable

Other Arrangement (explain below)
A $500.00 Non-refundable Deposit is required to guarantee Speaking date.*

I will send a check made payable to DINAO, LLCEmail me an invoice via PaypalCashMoney OrderCredit/Debit CardCash App to $Divorceisnotanoption
Travel Arrangements

(Includes- Hotel, Meals, Air Fare, Rental Car, General Transportation)
Please select an option*

This event is in Hampton Roads, VirginiaThis event is outside of Hampton Roads. Email me a travel estimate.
Payment Terms

Please check to show your understanding and agreement with the terms below
Confirm agreement by selecting both*

I agree to pay in full all financial obligations including travel expenses due to Speaker 30 days prior to his/her engagement.I agree to make checks payable to DINAO,LLCI agree to all terms identified on Booking FormI understand all fees are nonrefundable and non transferable.
Terms of Agreement
Check to agree with terms*

The submission of this form does not constitute confirmation for reservation of services or approval. It is a request for a quote of services and to check availability.
Signature

Clear
Should be Empty:

Booking Agreement

Honorarium Pricing

Travel Arrangements

Payment Terms

Terms of Agreement