SPEAKING REQUEST QUESTIONNAIRE

Thanks for your interest in booking Monique Shurray for a speaking engagement.

Please complete the questionnaire below. We will get back to you within 1-2  business days. For questions, please email monique@moniqueshurray.com

Sign in to Google to save your progress. Learn more
Email *
Primary Event Contact Name
*
Primary Event Contact Telephone
*
Primary Contact Title/Relationship to Event
*
Company/Organization/Group
*
Organization Website
*
Name of the Event *
Date of the Event
*
MM
/
DD
/
YYYY
Is there an event website? (Please include link)
Is this event virtual, in-person or hybrid?
*
If in person, where will this event be held? (Name of event space, city & state)
If not local, will ground transportation and lodging accommodations be provided?

Note: Monique Shurray travels from the Kansas City, MO area and requires lodging and travel accommodations for engagements outside of the city.
Number of Attendees Expected
*
Purpose of Event: What do you want your participants to walk away with?
*
What capacity/role would you like Monique Shurray to participate?
*
Topic: What would you like Ms. Monique to speak to?
*
Audience: Please share demographic information on expected attendees
*
Will this event be recorded? NOTE: If recorded, do you agree to provide a copy of the recording to Ms. Monique?
*
How long will you need Ms. Monique to speak?
*
Budget: What are you proposing to offer Ms. Monique as a Speaker Fee?
*
Any additional details you’d like to add?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report