Speaker Request

So! You Want a Speaker?!
Thank you for this wonderful opportunity to work with you! Please complete this questionnaire! The time you invest in thoroughly completing this will help assure I deliver the BEST presentation possible, specialized to fit your needs!

I am looking forward to working with YOU!

Thanks!

ABOUT YOU
Full Name *

First Name Last Name
Phone *

Area Code Phone Number
E-mail *
Organization Requesting Speaker *
Your Role or Title *
Organization's Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Organization's Website
Organization's Facebook Page Link
Event Page Link
Are There Any Additional Details That You Would Like to Share?

ABOUT THE VENUE
Venue Details & Location *

Venue Name

Street Address

City State / Province

Postal / Zip Code Country
Venue Contact

First Name Last Name
Venue Phone Number

Area Code Phone Number
Will Coach D Nicole Be Allowed a Vending Area? *
Will a Sound System & Engineer Be Present? *
Are There Any Additional Details That You Would Like to Share?
Should be Empty: