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

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Email *
Primary Event Contact Name
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Primary Event Contact Telephone
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Primary Contact Title/Relationship to Event
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Company/Organization/Group
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Organization Website
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Name of the Event *
Date of the Event
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MM
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DD
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YYYY
Is there an event website? (Please include link)
Is this event virtual, in-person or hybrid?
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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
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Purpose of Event: What do you want your participants to walk away with?
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What capacity/role would you like Monique Shurray to participate?
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Topic: What would you like Ms. Monique to speak to?
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Audience: Please share demographic information on expected attendees
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Will this event be recorded? NOTE: If recorded, do you agree to provide a copy of the recording to Ms. Monique?
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How long will you need Ms. Monique to speak?
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Budget: What are you proposing to offer Ms. Monique as a Speaker Fee?
 *
Any additional details you’d like to add?
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