Speaker Booking Request Presentation Request * Please check all that apply. Teaching/Preaching Keynote Presentation Workshop Facilitator Expert Panelist Event Host Other Presentation Request Other Presentation Request Please describe your presentation request. Contact Name * First Name Last Name Contact Position/Title * Contact Email * Contact Phone * (###) ### #### COMPANY INFORMATION Company/Organization Name * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Company/Organization Website Type of Experience * Please check all that apply In-Person Experience Live Virtual Experience Recorded Virtual Experience Hybrid (In-person + Virtual Broadcast) Experience Customized Workshop Experience [Describe Below] Customized Experience Are you interested in a customized workshop experience? Please provide your learning outcomes? Event Name * Event Location * Date * MM DD YYYY Start Time * Hour Minute Second AM PM End Time * Hour Minute Second AM PM Presentation Length * How much time do we have to present? Event Attire * Business Casual Business Semi-Formal Formal Ticketed Event * Are you selling tickets for your event? Yes No Speaker Budget * Do you have a proposed budget for this presentation/speaker? $20,000+ $10,000 - $20,000 $5,000 - $10,000 $2,500 - $5,000 $1,000 - $2,500 Under $1,000 Estimated Number of Guests * How many attendees are you expecting? Audience Demographic * Please describe the audience we will be addressing during your event. ADDITIONAL INFORMATION Product Table | Promotional Material * May we promote and sell products at your event? Yes No Video Recording | Photography * Are we allowed to take pictures and/or record video images at your event? Yes No Stay Connected * Would you like to stay connected to your speaker's upcoming events and news? Yes No Multiple Dates/Additional Appearances If you have multiple dates and times for your event please add that information here. Also, if you'd like for your speaker to make additional appearances, please indicate that here as well. Questions & Comments Thank you!
