Booking Request Form

 

Please complete the form below

Please submit speaking requests at least 2 weeks prior to the event. Please allow 3-5 business days for a decision to be made.

Name *
Name
Type of Event
Event Location
Event Location
Event Date *
Event Date
Event Time *
Event Time
(conference, dinner, small group, television, radio, etc.)
(if applicable)
http://
(keynote address, roundtable, panel, etc.)
(30 minutes, 1 hour, etc.)
(Will the speech/appearance be followed by a Q&A session?)
(Approximate size of audience. Also briefly describe its make-up and if membership is required to attend.)
(List names and titles of members of Congress, CEOs, or other VIPs participating in, or attending the event.)
(Will media be invited? If so, will the event be open or closed press? Also describe and submit media list.)
(please include member and nonmember price, if applicable)
(honorarium, none, dining, lodging, travel, etc.)
(Please indicate whether or not the event sponsor will need the speaker to sign a disclaimer/release form.)