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Dominique Da Diva Speaker Request Form
Thank you for your interest in having Dominique Da Diva speak at your upcoming event. In order to help us facilitate your request, please complete and submit the following form.
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Email
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Today's Date
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Name of the organization submitting the request
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Company URL
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Contact Name
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Title
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Email
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Phone
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Event Name (if applicable)
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Event Date
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City, State
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Event Start Time
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Time
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Event End Time
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Time
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Speaker time required at event
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Event Details
Venue
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Theme
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Goal
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Ticket Price(s)
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Expected Audience Size
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Audience Demographics
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Confirmed Speakers (if applicable)
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Past Speakers (if applicable
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Confirmation Deadline
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Event Press
Will there be a step and repeat red carpet?
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Will media be invited to attend?
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Will speakers be expected to do interviews?
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Yes
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Speacial Promotion
Social media outlets (Instagram, Twitter, Facebook) and frequency of posts
Please detail any requests for social promotion
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Compensation
What is your speaker budget for this event?
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Is travel and hotel assistance provided separately from the speaker budget?
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Presentation Details
Type of Presentation
Keynote
Presentation
Panel
Brunch/Luncheon/Dinner
Q&A
Roundtable
Other:
Topic of Presentation
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