National Motivational Speaker, Artist, Author and Businesswoman











 
Speaker Engagement Form

Date(s)/Time(s) of Event*

MM		/
DD		/
YYYY
HH		:
MM
AM/PM
Name of Event*
Audience*
Topic/Theme
Number of Attendees Expected
Length of Speech or Workshop
Organization/Company/Church*
Contact Person*
Address*

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Phone Number*

###		-
###		-
####
Email*

Please make available 1 or 2 tables for book
signing and item display.

Please let us know if
we will need to provide the following information.

Please let us know if we will need to provide the following information.
Photo for Advertising
 Color 
 
 B/W 

Biography/Credentials? Available Online

A description of the section goes here.
Will you be taping the event?
 Audio 
 
 Video 
(Please make available 1 free copy of video and
audio taping for speaker)
Workshop Layout
 Yes 
 No 

Please indicate the name of providing agent for
each item that is applicable with your event.

A description of the section goes here.

Air Transportation

(Large plane preferred)
Airline Carrier/Flight Information

Hotel Accommodations

(Non Smoking Room)
Name/Location/Phone

Car Service

/Ground Transportation
Transportation/Person
Transportation Provider Phone Number

Honorarium/Fee

is negotiable and will be determined upon confirmation.
However please provde proposed amount$
Print Name & Title of Authorizing Agent
Email
Email
Powered byEMF Email Form
 

Home  |  A Wise Choice  |  About Donna  |  Author  |  TBAGS  |  Speaker Engagement Form  |  Facebook

© 2010 W.I.S.E.
Designed by Darlene's Personal Touch