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Dr. Tori Speaking Request Form
Dr. Tori offers keynotes, presentations, in-services, and workshops. Each presentation, etc. is tailored to the specific needs of your audience.
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Name
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Email
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Phone
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Organization
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Category
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Choose
Conference
Academic
Retreat
Presentation
Workshop
Keynote
Inservices
Other
Date of the talk
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MM
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DD
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YYYY
Event location
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Event description (theme etc.)
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Are there topics or areas of particular interest you’re interested in hearing about from Dr. Tori?
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Expected Duration: (30 minutes, 1 hour, Q&A, etc.)
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Describe your audience
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What is the size of the audience?
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Choose
Less than 50
50-100
100-500
500-1000
+1000
What are the sticky problems that this audience faces?
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Estimated Budget? (honorarium, travel expenses, etc.)
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Do you ask the audience to evaluate the presentation?
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No
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Website
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How did you hear about Dr. Tori?
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Comments/Questions
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