Speaker Request Form
* Required
Your name:
*
This is a required question
Your email:
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Event date:
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Event type:
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Number of speaking/teaching engagements:
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Schedule & duration of speaking times:
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Is Tim the main speaker?
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Yes
No
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Other speakers (if applicable):
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Estimated number of attendees:
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Makeup of attendees:
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Organization name & mailing address:
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Contact person for event:
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Contact phone number & email:
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How did you hear about Tim Stevens?
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Overall purpose of event:
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Requested topic:
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Location & address of event:
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Will you need a headshot and bio of Tim Stevens?
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Yes
No
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Would you be willing to provide travel accommodations for Tim to bring an additional guest?
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Yes
No
This is a required question
What typical honorarium do you provide for this event?
*
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