Your Name

Your Phone

Your Email

Speaking Topic

Event Date

Specify Time of Event (eg: 7:00PM)

Event Location Name

Event Location/Address

Length of Presentation Needed?

Multiple Presentations Needed? YesNo

Audience Size

Describe the Audience. What do they do?

What are Their Challenges?

What do They Need to Learn/Take Away from this Session?

What A/V Equipment is Available?

Will you Film the Event? YesNo

Is there Internet Access Avaialble? YesNo

Is there a Vendor Table Available for Books/Products Sales? YesNo

Are You Interested in Purchasing Books for the Audience? YesNo

What is Your Budget for this Presentation?

What are the Guidelines for Travel Budget and Arrangements? (Should we book the travel or will your company handle that?)

Additional Information