Speaker Request Form
Thank you for your interest in having Lurie Daniel Favors, Esq. speak at your event. Please submit the information requested below for consideration. Due to scheduling constraints, Ms. Daniel Favors will not be able to accommodate requests less than 4 weeks or more than 8 months in advance of an event. Please complete with as much information as you currently have about the event and you will be contacted by a member of our team.
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Name of Sponsoring Organization *
Sponsoring Organization Website *
Contact Name and Relationship to Sponsoring Organization *
Contact Email *
Contact Phone Number *
Program Name *
Program Description *
Event Location *
Event Date *
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Event Start Time *
Time
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Event End Time *
Time
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Budget for Speaker *
Requested Speaker Topics *
Desired Presentation Length *
Due date for written materials and biography? *
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Type of Presentation *
If "other" please specify
Confirmation Deadline *
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DD
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YYYY
Will this event be: *
Will this event be video taped? *
If this event will be video taped, will you provide Ms. Daniel Favors with a copy of the video? *
Will there be media coverage? *
Audience Composition/Demographic *
Approximate Audience Size *
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