SPEAKING ENQUIRY/BOOKING FORM Thank you for your interest in having me speak at your event. Please complete and submit this speaking questionnaire. I will be in touch to discuss pertinent details. *fields are required GENERAL INFO: *Please select one of the following: General EnquiryPlease Send a Talk OUTLINE for Our GroupPlease Send some Talk OPTIONS for OUR BUDGETPlease Send a Talk COSTING for Our Group/EventPlease Send SUGGESTIONS of Other Possible Speakers SESSION INFO: Please select an optional budget (Supplying even a rough budget is helpful as we can usually provide you with some option(s) at most levels): No budget (non-profit etc)$500 - $1000$1000 - $2000$2000 - $4000$4000+ Type of Attendees (e.g. executives, self-employed, employees, mixed etc): Expected # of Attendees Session Duration: Goals for the Session: Session Date or Proposed Dates: Session Duration: PERSONAL INFO: *First Name: *Last Name: Company Name: Address: *City: *State: *Country: *Country: Zip/Postal Code: *Email: Phone (Business): Ext: Phone (Mobile): Event Title: Event Date/Time: Alternative Date/Time if requested date not available: Event Location: Event Description: No of Participants: Speaker Topic/Themes: Comments/Questions: Share Facebook Twitter Google + Pinterest