BOOKING FORM Booking Contact InformationName(Required) First Last Email Contact Phone(Required) Event InformationEvent Name(Required) Event Date(Required) Month Day Year Event Venue Location(Required) Requests for EventRequested Topic(Required) Length of Requested talk?(Required) Expected Number of People?(Required) When considering the organization and attendees, what would make this talk a success?(Required)Is there compensation for this event?(Required) Yes No Is your organization prepared to pay a $250 non-refundable speaker fee deposit to lock in the date and time?(Required) Yes No Consent(Required) I agree.All speaker fees must be received, in full, no later than 24 hours PRIOR to the the start of the event. This is required to avoid postponement or cancellation Email to send deposit invoice(Required) Will your organization cover travel and lodging expenses?(Required) Yes No MediaWill the event be professionally recorded? Yes No Will the event be professionally photographed Yes No How did you hear about me? PhoneThis field is for validation purposes and should be left unchanged.