PRELIMINARY SPEAKER ENGAGEMENT INQUIRY FORM Preliminary Speaker Engagement Inquiry Form Thank you for your interest! To help us understand your needs and ensure our speaker is a great fit for your event, please complete the brief questionnaire below. We look forward to learning more about your event. 1. Basic Information Name * Name First Name First Name Last Name Last Name Organization/Company * Email Phone 2. Event Overview Event Name * Brief Event Description * Event Date Event Time 101112123456789 : 0030 AMPM Event Address Event Address Event Address Event Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Expected Audience Number * 3. Presentation Needs Desired Topic(s) or Themes * Length of Presentation * Audience Demographis (e.g., professionals, students, industry type): 4. Budget & Logistics Estimated Budget Range * 1000 Are you covering travel expenses? * Yes No The event is virtual 5. Additional Comments Is there anything else we should know about your event or audience? * Submit If you are human, leave this field blank.
