Speaking Event Questionnaire
Please submit the information below regarding your interest in booking Lonnie Bedwell. Thank you!
First Name *
Last Name *
Company or Organization Name *
Your Title or Role *
Phone Number *
Email *
Venue Name for Requested Event *
Requested Date (optional if your dates are flexible)
MM
/
DD
/
YYYY
In which time range would the event be?
Clear selection
What is the theme of your event? *
Will there be any other speakers at this event? Who? *
What goals do you hope to achieve with booking Lonnie? Are there any specific topics you would like him to address? *
What size audience do you expect will attend? *
Tell us a little about your audience. Who will attend? Include if this event corporate, non-profit, fundraiser, education, etc. *
What AV equipment will you have available for use? Please check all that apply: *
Required
Because Lonnie is visually impaired, requires assistance getting to/from the airport, hotel and speaking venue as well as an assistant to help with AV setup and power point slide show. Will you be able to provide this assistance? Please note, if you are unable to provide the assistance. For an additional cost an assistant for Lonnie will accompany him to provide these services. *
Any other comments?
Thank you!
We will be in touch very shortly. We look forward to working with you.
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