C. Berger Speaker Request Form
Please provide details about your event and speaker requirements below.  Responses will be submitted directly to crystal@cbinspires.com.
Email *
Sponsoring Organization *
Point of Contact *
P.O.C. Title
P.O.C. Email *
Website URL *
Phone number *
What service would you like to retain CB to conduct?
Clear selection
What is your budget for event speaker? *
Required
Title of Event
What is the biggest need to be addressed with/in your organization?
What would you like participants to walk away with after the session, speaking engagement and/or event?
Event Location
Clear selection
Proposed Topic(s):
Date of Event
MM
/
DD
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Time of Event
Time
:
Time of Speaker’s Presentation:
Time
:
Length of Presentation:
Approximate Size of Audience Expected: *
Additional Demographics (audience needs, age, religion, etc.):
Due Date for written materials & biography
MM
/
DD
/
YYYY
E-mail where written + electronics materials can be sent:
If audio/visual is used, is the sponsor capable of making arrangements?
Contact for audio/visual arrangements
Will this event be recorded?
Clear selection
If so, will sponsor organization provide electronic files of footage once produced?
Clear selection
**Provide instructions on parking accommodations, speaker arrival time, reporting location upon arrival, etc.
A copy of your responses will be emailed to the address you provided.
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