SPEAKER QUESTIONNAIRE
PLEASE COMPLETE THIS QUESTIONNAIRE IN ITS ENTIRETY.
FULL NAME *
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OCCUPATION/TITLE *
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COMPANY/ORGANIZATION *
Your answer
WEBSITE *
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EMAIL ADDRESS *
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PHONE NUMBER *
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SOCIAL MEDIA HANDLES *
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EVENT NAME *
Your answer
EVENT DATE *
MM
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DD
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YYYY
EVENT TIME *
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EVENT LOCATION *
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Will travel and accommodations be provided? *
What is the nature of this speaking opportunity? *
Length of Presentation *
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Visual aid requested with presentation *
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Expected number of attendees? *
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Ticket Cost? *
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Speaker Budget/Honorarium Offered *
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Will there be an event photographer? *
Will there be an event videographer? *
How will you market this event? *
How did you find out about Tia Pugh? *
Additional Comments
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