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Pre-Event Questionnaire
Please complete this pre-event questionnaire. The RNC team looks forward to reviewing your full request. Should you have additional questions, please contact
info@drlaci.com
or 414.909.1090
Thank you!
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Email
*
Your email
Organization/Association (please provide an informational overview.)
*
Your answer
Organization/Event Website
*
Your answer
Contact's Name & Title
*
Your answer
What is Your Role with Regard to Planning the Event?
*
Your answer
Contact's Address/City/ State/Zip
*
Your answer
Contact's Email
*
Your answer
Contact's Phone
*
Your answer
Event Location (City/ State/ Venue)
*
Your answer
What is the Date of the Event?
*
MM
/
DD
/
YYYY
What Time Would Dr. Laci Speak?
*
Time
:
AM
PM
What is the Purpose of the Meeting/Event?
*
Your answer
Describe the Demographic and Profile of the Group to be Addressed.
*
Your answer
What is Your Proposed Budget?
*
Your answer
Dr. Laci travels from Milwaukee, WI. Is Travel/Lodging Included for the Speaker, PLUS One Assistant? What is the Closest Airport? Will Ground Transportation and Meals be Provided?
*
Your answer
Would You Like Dr. Laci to Complete a Book Signing at this Event? How Many People Will Attend? Are You Interested in Pre-Ordering Books?
*
Your answer
Which Services are Requested for Dr. Laci to Provide?
*
Keynote Speaker
Panel Participant
Conference Workshop
Private Seminar
Moderator
Other:
Required
What Topic Would You Like Dr. Laci to Address?
*
Your answer
Is There More Than One Appearance Requested?
*
Yes
No
The Presentation is Slated for?
*
30 minutes
60 minutes
90 minutes
Other:
Additional Comments
*
Your answer
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