Your Name:
Company Name:
~
Website: (www.YourWebsite.com)
Bureau Friendly Site:
(www.BureauFriendlyWebsite.com)
~
Address:
City:
State:
Zip:
~
Phone:
Cell:
Fax:
~
Your E-mail Address:
Your Secondary E-mail Address:
~
What is your Fee for a Keynote (up to 60 minutes):
What is your Fee for a Half Day (at least 3 hours):
What is your Fee for a Full Day (at least 6 hours):
What type of Flight Travel do you Require?
~
What is the primary Topic that you offer?
What is a secondary Topic that you offer?
What is a third Topic that you offer?
What else should we know about your topic(s) ?
~
Do we have your Professional Demo Video?
Yes
No
Do we have your Professional Quality One-Sheet?
Yes
No
Do we have your Fee Schedule Sheet?
(This sheet that tells Event Planners your speaking, transportation and other fees.)
Yes
No
Give Us Three Or Four Sentences That Describe You:
Is there anything else you want tell us ?
