Speaking Engagement Questionnaire

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I appreciate your interest in having me be a part of your event. By answering the questions below, you are ensuring the most accurate, efficient response to your inquiry. I know you may not have all the details worked out for your event yet, so please fill this out to the best of your ability.

I can accommodate short-term and long-term planning situations, but please understand that due to the high volume of speaking requests and client work, my calendar fills up quickly. If you list an exact date of your event on this questionnaire, there is a 30-day "courtesy hold" placed on our calendar for that date. I am only considered "booked" for your event once a signed agreement is in place and deposit is received.

For your internal planning purposes, all mileage/train/air travel + lodging must be covered if event is outside of the Hampton Roads/Richmond region. Our travel originates from Norfolk, VA (car), Norfolk, VA Amtrak Station (train) and Norfolk International Airport (air).

Nikki James Zellner, activist, speaker and founder

What is your full name? *

What is the name of the event, organization or association you're requesting information on behalf of? *

What is the best phone number to reach you on for primary communications? *

What is the best email to reach you at for primary communications? *

What is your preferred method of communication in response to this request? *

Phone

Please list website we can reference related to your event, organization or association. *

What industry best represents your event, organization or association? *

Estimated or exact date of your event? *

If unknown, please mark with TBD or Flexible.

YYYY

Time

Location (city/state/country) where your event will take place? *

If this is a virtual event, please reply with VIRTUAL.

Anticipated format of your event? *

Please check all that apply.

Conference

Large Group Setting (auditorium, gymnasium)

Small Group Setting (large room or small room)

Virtual Event (Webinar, Online Summit, Facebook Live)

Unsure at this time/Open to Discussion

Required

I'm interested in booking Nikki as a... *

Keynote speaker

Workshop/Breakout Session facilitator

Panelist or Q&A Interviewee

Moderator/Emcee of session or event

Small group presentation (Lunch N Learn, small team workshop) - less than 15 people

I'm not sure yet, it's a custom job!

Required

Below are some of the topics we cover based on years of personal + professional experience. What topic(s) are you most interested in being covered at your event or do you feel would most resonate with your audience? *

Connecting the Dots: The Four C's of Intentional Content (for brands and brand builders)

Creating Better Content to Grow Communities (for DMOs, tourism, regional cities + governments)

Find Your Angle - pitching opportunities, strategies for today's personal + professional brands

Don't Miss the Mark - Marketing to military-connected families

Watchdogs: Embrace your role in building stronger communities (all)

Required

Due to high volume of speaking requests, please help us categorize this request. Are you looking to book Nikki for a: *

Note: Pro-bono speaking engagements are considered on a case by case basis. For all paid speaking engagements, you will receive an estimate based on the needs you outline in this questionnaire, which may or may not reflect your final pricing.

Paid speaking engagement

Pro-bono speaking engagement

Required

Anything else you'd like to share with me as it relates to your event, organization or reach out? *

(Things like budget, concerns, outcomes, etc.)

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