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Speaking Engagement Questionnaire
Saturnie L. Antoine, CPC- Certified Professional Relationship & Executive (FEMININITY) Coach, Mentor, & Speaker
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* Indicates required question
Email
*
Your email
Event Info
Name of Event (Title and theme)
*
Your answer
Event Type
*
In person Speaking Event
Virtual (Video / Webinar)
Radio Interview
Magazine Interview
Television Interview
Other
Your Name
*
Your answer
Your Company / Business Name
*
Your answer
Your country and city
*
Your answer
Your time zone! (Please note that our time zone is EASTERN TIME)
*
Your answer
Event Date
*
MM
/
DD
/
YYYY
Venue Name and Address (if in person). Put "N/A" If not applicable.
*
Your answer
Room Name (If Applicable). Put "N/A" If not applicable
*
Your answer
Beginning Time (in EASTERN TIME)
*
Time
:
AM
PM
End Time (in EASTERN TIME)
*
Time
:
AM
PM
Expected Number Of Attendee(s)
*
Your answer
Program Info
How many speaker(s) will there be?
*
1 (Coach Saturnie L. Antoine)
2
3
4
5
Other:
What is the length of the speech / presentation expected to be?
*
15 Mins
30 Mins
45 Mins
60 Mins
Other:
What will come before and after my time? Please give a brief description of the program.
*
Your answer
Will there be an intermission / break time?
*
Yes
No
Specific purpose of this meeting/session/interview (e.g. awards banquet, annual meeting, etc, community engagement etc)?
*
Your answer
Specific objective(s) for my presentation?
*
Your answer
Are there any sensitive issues that should be avoided?
*
Your answer
Topics / Themes / Issues that should be focused on
*
Your answer
What are you looking forward to the most from the presentation? Please share any suggestions or comments that will help me make this presentation the best presentation for your audience.
*
Your answer
What is your budget for this booking? Speaker's fee to be discussed. (If this is a pre-existing partnership, please indicate below.)
*
Your answer
Audience Info
Please check all that applies
*
All Women
All Men
Both Men & Women
Young Girls
Couples
Singles
Married
Other:
Required
Average Age Group
*
Your answer
Emergency Info
If an emergency occurs on the way to the venue or before the event, who would be an alternate contact if you are unavailable? (Please provide a name and phone number if applicable). Put "N/A" If not applicable.
*
Your answer
Other Info (if applicable)
Airport to arrive at (Airport Name) - If applicable. Put "N/A" If not applicable.
*
Your answer
Will transportation be provided from the airport to the venue? If so, please indicate below (If applicable).
*
Taxi
Uber
Lyft
Rental Car
Driver
Other
Not Applicable
Your Info
Your Full Name
*
Your answer
Phone Number
*
Your answer
Instagram @Name
*
Your answer
Thank you for choosing me as your speaker; I truly look forward to being a part of your event!
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