Company/Association/Organization

Contact Name & Title

Contact's Email

Contact's Phone Number

What is your role in planning the event?

Event Location/Address

Date & Time of the Event

Type of Event/Purpose of Event

Demographics of Group & Number of People Expected

Desired Topic & Theme of the Event

What is your budget?

Is travel & lodging included for Ms. Richard Thompson?

What is the closest airport? Are ground transportation & meals provided? (if applicable)

What exactly would you like Ms. Richard Thompson to do? (keynote, training, panel participant, etc.)

How long would you like her to speak?

Additional Comments or Information