Maria Shriver Speaking & Appearance Request Form
Email address
Your Name & Title:
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Name & Brief Description of Event:
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Date & Location:
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Audience Size
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Is this event open to the public? Are tickets being sold?
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Format of Event
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Topic or Theme of Speech
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If you are requesting that Maria serve as a moderator at your event, please provide the names of the individuals who will be a part of the discussion.
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If you would like to honor Maria with an award, please give all pertinent details about the ceremony. Will she be asked to make a speech? Who will introduce her? What other awards will be given at the ceremony? (Please provide names of recipients if available.)
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If this is an award, please share the names of recipients from past years.
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Do you cover travel/accommodations?
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Is there an honorarium?
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When you need an answer by?
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Your contact information (name, phone number and email):
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Referral or Relationship to Maria:
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