Speaking – Pre-Event Questionnaire

Name of Company/Association

My organization is a… My organization is a… Corporation Conference College Other (Please specify)

If you selected other, please specify:

First Name

Last Name

Best Email to Reach You

Contact Number

Event Location (City, State, Venue)

What is the date of the event?

How many people will be attending?

What date and time would Alicia speak?

What exactly would you like Alicia to do? What exactly would you like Alicia to do? Keynote Serve as a Conference Speaker Serve as a Workshop Leader Appear as a panelist Serve as a Facilitator Other

If you selected other, please specify:

What topic would you like her to address?

How long would the talk last?

Is there more than 1 appearance requested?

Tell us briefly about the event, it’s purpose, and the demographic of the attendees.

What does a successful event look like? Please provide metrics for success Alicia will be expected to deliver.

What is your speaker fee budget?

Would you like for Alicia to do a book signing at the event? Would you like for Alicia to do a book signing at the event? Yes No

Would you like to pre-order books? Would you like to pre-order books? Yes No

If so, approximately how many?

Is there anything else you’d like for us to know?