Beverley Andre
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Speaker & Trainer Inquiry
Email Address
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First Name
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Last Name
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Organization
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Organization's Website
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Organization's Status
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For Profit
Non-Profit/ 501(c)(3)
Event date
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Event location
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Event Website
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In Person or Virtual?
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In Person
Virtual
Expected number of attendees / participants
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Is the event free for attendees
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Yes
No
If the event is not free for attendees how much is registration/admission for each attendee?
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Other speakers/Invited Guest
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Event sponsor(s)
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Type of presentation requested
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Timed Talk (list time under additional info)
Keynote Address
Event or Panel Moderator
Panel Discussion
Workshop/ training
Budget for requested speaker / presentation
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Other special requests
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Meet and Greet
Speaker Attendance at Breakfast, Lunch, Dinner or Reception
Photo / Video permission
Media Interviews
Other (list under additional info)
What do you want attendees to get out of your event
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Can contact forms or info sheets be given to attendees?
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Yes
No
Can products be sold at this event?
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Yes
No
Additional comments and/or information about your Event: (Target audience/focus) event?
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In addition to submitting a completed form, send any supporting documents/ files pertaining to request to
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