JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Author Visit or Speaking Request
Please use this form to request that Courtney Kelly visit your organization for an author visit or speaking engagement. Requests need to be submitted at least one (1) month in advance of the date you would like Courtney to be be present.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Organization or School's Name
*
Your answer
Your Name
Your answer
Your Phone Number
Your answer
Proposed Date(s) of Appearance
If flexible, please provide up to 3 options.
*
Your answer
Audience Details
Number of sessions, number of participants per session, anticipated grade level/age range per session.
*
Your answer
Type of Service
Please select what type of service you would like.
*
Author Visit (In-Person)
Author Visit (Virtual)
Book Signing
Motivational Speaking
Professional Development Presentation
Writing Workshop
Other:
Location of the Event
Please note that Courtney is based in Dallas, Texas.
Hosts are responsible for any applicable travel expenses, including airfare, gas/mileage/rideshare service, hotels, and meals.
*
Your answer
Budget for Event
Please provide any details about the budget for the event. Speaking fees can range from $500-$2,000 or more per day.
*
Your answer
Books for Event
Books purchased in advance for an event will be provided at a 40% discount. Please also indicate if Courtney Kelly Books will be available to sell books at the event.
All books will be autographed by Courtney.
*
I would like to purchase books for this event.
Courtney Kelly Books will be able to sell books at this event.
Additional Comments
Please provide any additional comments that have not been addressed above or additional information that would assist Courtney in making a decision about this request.
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Courtney Kelly Books.
Report Abuse
Forms
