SPEAKING REQUEST QUESTIONNAIRE

SPEAKING REQUEST QUESTIONNAIRE

Thank you for your interest in having Dr. Nicole Roberts Jones as a speaker at your event or podcast. Please take a moment to complete the questionnaire and we will get back to you within 24 - 48 hours.
Name

First Name Last Name
Your Email
example@example.com
Company/Organization/Group *
Are you requesting Nicole to speak at your event or as a guest on your podcast? *

Speaker At My Event Be On My Podcast
Website Address *
Primary Contact Name *
Primary Contact Telephone *
Primary Contact Email *
Date of the Event (if podcast just write n/a) *
Location of the Event (if podcast just write n/a) *
Number of Attendees Expected To Attend Event or Listeners if a Podcast *
Purpose of Event/Podcast: What do you want participants to walk away with? *
Topic of Interest: What would you like Nicole to speak on?

Purpose: Get Aligned: The 4 Steps To Align Purpose With Paycheck Entrepreneurship: Bankroll Your Brilliance: 3 Steps To Create Multiple Streams of Revenue From What You Know Church or Faith Based: MULTIPLY: How God Wired You To Live Abundantly
Who is the audience? *
How long would you like Nicole to speak? *
Is there an event/podcast website? (please include link) *
What is your promotion plan? TV, Radio, Social Media, Internet, Other *
Are you proposing to offer Nicole an Honorarium/Speaker Fee? *
If this event is outside of the Washington DC area, what expenses have you budgeted for Nicole's travel, transportation and overnight accommodations? *
Is this a ticketed event? If so what is the ticket price *
Will this event be recorded? *
If Nicole accepts, we will provide a professional high-res head shot, written and read-it bio for marketing purposes. We do not approve nor authorize any likeness to Nicole Roberts Jones or Nicole Roberts Jones photos, videos or content from the public domain (i.e. internet, social media pages, web pages, etc.) Do you agree to honor our request? *
nicolerobertsjones.com > Booking@NicoleRobertsJones.com
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