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Melissa D. White Speaker Request Form
Please completely fill out the form and allow up to 2 business days for a response.
Email address *
Event Title *
Your answer
Event Date *
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YYYY
Event Time *
Time
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Event Description *
Your answer
Is there and admission fee? If so, how much? *
Your answer
Host Company/Organization Name *
Your answer
Event Address *
Your answer
Website
Your answer
Event Coordinator Name *
Your answer
Contact Number *
Your answer
Email Address *
Your answer
Please describe the audience and estimated attendance. *
Your answer
What topic would you like for Ms. White to discuss? *
Your answer
What overall message would you like for participants to leave with? *
Your answer
How would you like for Ms. White to serve at your event? *
What time is Ms. White expected to arrive? *
Time
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How long is Ms. White expected to speak? *
Time
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What is the budget allotted for Ms. White's speaking services? *
Your answer
Will ground transportation and meal be provided? (* Ms. White travels from Atlanta, GA and requires lodging, travel, and meal accommodation for engagements outside of the city. The nearest airport is Hartsfield International Airport*) *
Is a table allowed for promotional products? *
Are you interested in pre-ordering any of Ms. White's products for your event? (*products include books and apparel) *
A copy of your responses will be emailed to the address you provided.
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