Conference Speaker Request Form

SPEAKING REQUEST QUESTIONNAIRE

If you or your organization/company would like to request Victoria Jenn for a speaking engagement or appearance, please complete the attached questionnaire.
Name*

First NameLast Name
E-mail*
example@example.com
Company/Organization/Group*
Phone Number*
Format: (000) 000-0000.
Date of the Event*

MonthDayYear
Date
Location of the event*
Will this event be recorded?*
Is this a ticketed event?*
Number of Attendees Expected*
What is the audience profile?*
Topic of Interest: What would you like Victoria Jenn to speak to?*
How long will you need Victoria Jenn to speak? *
What are you proposing to offer Victoria Jenn as an Honorarium/Speaker Fee?*
What expenses have you budgeted for Victoria Jenn's travel, transportation and overnight accommodations? *
How do you plan to market and advertise your event?*
Event Website*
Please include link
Any additional notes about the event you would like us to know?
Should be Empty:

SPEAKING REQUEST QUESTIONNAIRE