Speaking Engagement and Event Participation Request Form
Request Christopher Tyler Burks to speak and participate in your event by completing this form.
Requesting Organization *
Your answer
Contact Person (full name) *
Your answer
Contact Phone Number *
Your answer
Contact Email *
Your answer
Event Name *
Your answer
Event Location (include full address) *
Your answer
Event Date *
MM
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DD
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YYYY
Event Start Time *
Time
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Event End Time *
Time
:
Is Mr. Burks's participation needed for the entire event? *
Required
If No, What time is Mr. Burks' participation needed? (from ____ am/pm to ____ am/pm)
Your answer
Target Audience *
Your answer
Number of People Expected *
Your answer
Dress Code (if any)
Your answer
Event Theme (if any)
Your answer
Is there a topic or subject that should be addressed in Mr. Burks' remarks? *
Your answer
Does the group have any special causes or concerns that should be addressed? *
Your answer
Preferred Length of Comments *
Your answer
Are there people in the audience who should be recognized (dignitaries, politicians, donors, etc.)? If so, who?
Your answer
Are there any other speakers? If so, who?
Your answer
Thank You!
Thank you for the invitation to participate in your event! The completion of this form helps Mr. Burks prepare for the event and meet your needs. The completion of this form does not confirm acceptance. Mr. Burks will contact you to accept. Thank you!
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