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Speaker Request Form
Please answer the questions in as much detail as possible. Thank you!
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Company/Organization/Group Leader/President
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Website
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Primary Event Contact Name
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Primary Event Contact Phone Number
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Primary Event Contact Email
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Your answer
Date of the Event
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Location of the Event
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Number of Attendees Expected
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Purpose of the Event (What do you want participants to walk away with? Goal?)
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Format: In what capacity/role(s) would like Dr. Tammy to participate?
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Topic of Interest: What would you like Dr. Tammy to speak about?
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Audience: Who is your audience?
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Speaking Time: How long would you like Dr. Tammy to speak/present?
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Event Website (if different from website listed above)
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Promotion Plan: TV, Radio, Flyer, Internet, Other
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Will Dr. Tammy's presentation be recorded? If yes, how will the recording be used after the event? *Dr. Tammy requires special permission for recorded sessions, which must be approved prior to event. A contract addendum may be required depending on the type of event.
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Will you be purchasing any of Dr. Tammy's books for distribution or sell at the event? If yes, how many? Which title or titles? Please explain.
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What are you proposing to offer as a speaker fee?
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Have you budgeted travel and lodging, if necessary? Please explain.
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