Tamiko Lowry Pugh Speaker Request Form
Contact Name *
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Name of Company or Event *
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Phone *
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Email *
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Speaking Topic *
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Date and Time of Event *
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Event Location (city, state, and hotel/venue) *
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Length of Presentation Time *
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Anticipated Audience Size *
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Describe the audience. What do they do? What are their challenges? What do they want to learn/take away from this session? *
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A/V equipment available? *
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Will you film the event? (If so, we require a copy) *
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Internet access available? *
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Vendor table available for book/product sales?
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Interested in purchasing books for audience?
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What is your budget for this presentation?
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Onsite event contact name and cell phone number.
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Other Notes
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