Speaking Request Form for Rachel L. Proctor
I know how important choosing the right speaker is for your event! So thank you for considering me to speak to your group. Please take a few moments to fill out the questions below so that I can get a better feel for your event and how I might be able to help. Thank you!
Email address *
Today's Date *
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Name of Host *
Your answer
Name of Organization *
Your answer
Address (Street Name, City, State, Zip) *
Your answer
Name of the Primary Contact Person *
Your answer
E-Mail of the Primary Contact Person *
Your answer
Phone Number of the Primary Contact Person *
Your answer
Date and Time of the Event *
Your answer
What Date and Time Would Rachel Speak? *
Your answer
City/State/Country of Event *
Your answer
Proposed Venue *
Please list the address of the venue as well.
Your answer
Type of Event (i.e. Conference, Retreat, Seminar) *
Your answer
Theme of the Event
Your answer
Time Allotted for Rachel's Presentation *
Your answer
Anticipated number of attendees for this event *
Your answer
Demographic and Profile of Group(s) to be spoken to: *
Your answer
What exactly would you like Rachel to do (i.e. - keynote, conference workshop, private business seminar)? Is there more than one appearance requested? *
Your answer
Will Rachel be a part of a panel discussion which would include other panelists? *
If YES, what is the subject of the questions that will be asked on the panel?
Your answer
If YES, will the questions be provided prior to the event?
Budget For Speaker (please anticipate travel for two in addition to speaking fee) *
Your answer
Is travel/lodging included for the speaker PLUS one assistant? What is the closest airport? Will ground transportation and meals be provided? (Rachel travels from Dallas) *
Your answer
Will This Event Be Videotaped? *
Will there be an opportunity for Post Event Sales for Rachel? *
Her books, CD's, etc.
Would you like for Rachel to do a book signing at the event? *
Are you interested in pre-ordering books? *
Any Other Details Pertinent to this Request
Your answer
A copy of your responses will be emailed to the address you provided.
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