Speaker Request: Intake Form
Thank you for your interest in booking a speaker for your event. This Speaker Intake Form helps us collect all of the data needed to move forward and meet expectations for the event. 50% deposit along with a signed contract is required in order to finalize arrangements for a speaking engagement. The balance due of 50% should be payable on or before the day of the event. Booking Fee may apply
Contact Name *
Email *
Address *
Phone number
Name of Speaker Requested
List the name of the PBG Client/Partner that you wish to book as a speaker
Name of Organization/Group
Type of Organization *
Event Name & Description
Website Link of Event (If Applicable)
Suggested Speaker's Topic
Estimate audience
Description of Audience
Describe the audience. What do they do? What are their challenges? What do they want to learn/take away from this session? Please tell us if this program is for school children or the general public. If it is a school program please tell us what age or grade level the students are.
When is the speaking engagement? *
MM
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DD
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YYYY
What time will the event take place *
Time
:
Length of Presentation Time
Event Location (city, state, and hotel/venue)
A/V equipment available?
Internet access available?
Vendor table available for book/product sales?
What is your budget for this presentation?
What are the guidelines for travel budget and arrangements?
Normal arrangements for hosting our speakers (and a travel companion) to attend will include honorarium, hotel accommodation, local event ground transportation either by rental car/fuel or transportation arrangements by host at our discretion, meals, and coach round-trip airfare(s), ground transportation cost to and from the airport, and any other miscellaneous expenses that may be incurred related to your engagement, to be invoiced after the event.
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