Speaker Booking Form

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Thank you for inviting me to connect with you and your team at this event. Please provide the information required below

Name *

Email *

Phone # *

Fax # *

Mailing Address

Name of Company or Event *

Speaking Topic *

Date and Time of Event

YYYY

Time

Event Location (city, state, and hotel/venue)

Length of Presentation Time (in minutes)

Multiple Presentations Needed?

Yes

Required

Audience Size

Describe the audience. What do they do? What are their challenges? What do they want to learn/take away from this session?

A/V equipment available? What type?

Will you film the event? (If so, may we request a copy? If not may we record?)

yes

Internet access available?

yes

Required

Vendor table available for book/product sales?

yes

Required

Interested in purchasing books for audience?

yes

If yes, how many?

Other:

Required

What is your budget for this presentation?

What are the guidelines for travel budget and arrangements? Should I book the travel or will your company handle that?

Onsite event contact name and cell phone number?

Other Notes

Submit

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