SPEAKING REQUEST

Thank you for the honor of considering me as a speaker for your upcoming event or retreat. Below are some questions that will help us move forward.

In addition to the much appreciated honorarium I also ask that all travel expenses are covered. These costs typically include airfare or mileage, checked bags, meals, and hotel.

Name*
First Last
Title if Appropriate

(ex. Womens Director, Children's Pastor)
Phone Type
Phone Number*
Website
Name of Organization*
Where will the event be held?*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
What is the closest major airport and the distance from it to the event if applicable?
What is the theme and/or purpose of your gathering?*
Start Date of Event
MM slash DD slash YYYY
End Date of Event
MM slash DD slash YYYY
Start Time of Event

: Hours

Minutes

AM/PM
End Time of Event

: Hours

Minutes

AM/PM
How many other speakers will be there?
How many keynotes or sessions do you want me to present? What is the duration of each session?*
Please describe your target audience or potential attendee. (age range, stage of life, gender)*
How many attendees do you anticipate?*
What is your budgeted honorarium for this event?*
Please provide any additional information you think I would need.
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SPEAKING REQUEST

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