Speaking Event Questionnaire
Please submit the information below regarding your interest in booking Lonnie Bedwell. Thank you!
First Name *
Your answer
Last Name *
Your answer
Company or Organization Name *
Your answer
Your Title or Role *
Your answer
Phone Number *
Your answer
Email *
Your answer
Venue Name for Requested Event *
Your answer
Requested Date (optional if your dates are flexible)
MM
/
DD
/
YYYY
In which time range would the event be?
What is the theme of your event? *
Your answer
Will there be any other speakers at this event? Who? *
Your answer
What goals do you hope to achieve with booking Lonnie? Are there any specific topics you would like him to address? *
Your answer
What size audience do you expect will attend? *
Your answer
Tell us a little about your audience. Who will attend? Include if this event corporate, non-profit, fundraiser, education, etc. *
Your answer
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?
Your answer
Thank you!
We will be in touch very shortly. We look forward to working with you.
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