BoriquaChicks.com Speaker Request Form
If you are interested in having Boriqua Chicks speak at your next event, please complete the form below to the best of your ability.
1) Contact Name *
Your answer
2) Name of Organization Hosting Event *
Your answer
3) Description of Organization *
Your answer
4) Website
Your answer
5) Email *
Your answer
6) Phone *
Your answer
7) What type of speaking request do you have for Boriqua Chicks? *
8) Event Theme/Title + Overview
Your answer
9) Event Location (city, state, and hotel/venue) *
Your answer
10) Event Date
MM
/
DD
/
YYYY
11) Time of Event
Time
:
12) Desired Speaking Topic *
Your answer
13) Length of Presentation Time *
Your answer
14) Multiple Presentations Needed? *
15) If yes to 14, please explain.
Your answer
16) Estimated Attendance
Your answer
17) Describe the audience. What do they want to learn/take away from this session?
Your answer
18) Can we speak with potential audience members, prior to the event, so that we can better understand their interests and needs? (Relevant if requester is different from person booking Boriqua Chicks.)
19) What A/V equipment is available?
Your answer
20) Internet access available?
21) Will you film or photograph the event?
22) Vendor table available for Boriqua Chicks products(t-shirts, cups, etc.) sales?
23) Are you interested in purchasing Boriqua Chicks paraphernalia for audience?
24) What is your speaker budget for this presentation? *
Your answer
25) How will travel arrangements be taken care of? Should we book the travel and you will provide reimbursement OR will your organization book the travel and pay for it (disregard if in Chicago area)?
Your answer
26) Onsite event contact name and cell phone number? (Please complete if different from contact info above.)
Your answer
Additional notes or comments that we should know...
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