Date of Event:

Time of the event/Time of presentation:

Location:

Company/Organization:

Contact Person's Name

Contact Person's Email

How many will be attending?

Is attendance mandatory, or voluntary?

Who is the audience?

How long do you want me to speak?

What are one or two outcomes you want from my presentation?

Do you want the presentation to be interactive? What percentage?

What is the desired value for the audience?

What is the desired result for the audience?

What is your budget for speakers?

What is the room set-up?

What takes place immediately before presentation?

What takes place immediately after presentation?

Would you like to purchase my books or CD’s for your audience and/or can I sell them at the front of the room after my presentation?

Do I have permission to videotape my speech…
 for personal use for professional use on website/YouTube

If you are satisfied with my presentation, are you willing to…
 Evaluate my presentation (I will provide form) Write a testimonial I can use on my website and in printed material Provide two or more referrals Consider re-booking me for this and/or other events

Any other information, questions, etc?