Please copy and paste questions below into "Comment" section on the "Contact Us" page of this website and povide responses.

1.      Requesting Organization:

 2.      Requesting Organization Contact Info (Name, address, phone, fax, email):

3.      Organization Type: __For Profit / __Non-Profit

4.      Date and Time:

5.      Speech Duration (minutes, hours):

6.      Theme / Topic:

7.      Objective (Desired impact on audience):
 
8.      Other Scheduled Speaker Topics on This Date:  

9.      Audience Description / Size:

10.    Venue / Location Name and Description:
 
11.    Audio / Visual Setup (microphone, projector, teleprompter, laptop, flipcharts, etc.?):
 
12.    Handouts Requested Yes / No:

13.    Expenses Covered: Yes / No If yes, please provide details:
 
14.    Speaker Fee Provided: Yes / No If yes, please negotiate fee with speaker based on requirements: