Speaker Request Form
Please answer the questions in as much detail as possible. Thank you!
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Company/Organization/Group Leader/President *
Primary Event Contact Name *
Primary Event Contact Phone Number *
Primary Event Contact Email *
Date of the Event *
Location of the Event *
Number of Attendees Expected *
Purpose of the Event (What do you want participants to walk away with? Goal?) *
Format: In what capacity/role(s) would like Dr. Tammy to participate? *
Topic of Interest: What would you like Dr. Tammy to speak about? *
Audience: Who is your audience? *
Speaking Time: How long would you like Dr. Tammy to speak/present? *
Event Website (if different from website listed above)
Promotion Plan: TV, Radio, Flyer, Internet, Other
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. *
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. *
What are you proposing to offer as a speaker fee? *
Have you budgeted travel and lodging, if necessary? Please explain. *
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