Contact

Speaker Consultation Form

Please provide the following information about your event and speaker requirements and someone will contact you quickly. We ask that you provide as much specific information as possible so we can most effectively serve you.

Your Contact Information

Name *

First

Last *

Last

Email *

Website

Address *

Address Line 2

Phone: *

City *

State * ALAKARAZCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYNew OptionNew Option

Postal Code *

Please Describe Your Event

What date and time is your event scheduled?

City & Site of event or meeting:

What is your organization and/or type of business?

Who is your audience?

What is the approximate size of your audience?

under 30

30 - 50

50 - 100

100 - 200

200 -300

300 -500

500 - 1,000

1,000 - 4,000

How many programs will you have?

Length of presentation(s):

What is your event format?

Keynote

Training

Workshop

Seminar

Closing Session

Publicity/General Appearance

School Assemblies

Student Leadership Confrence

Please Describe Your Ideal Speaker(s)

Select any speakers you are already interested in booking: Richard Santana Ed.MChristina MariscalGuillermo “Willie” LopezDavid FranklinDaniel MoraAurora Lopez

What is your budget range for the ideal speaker?

$1,000 - $1,500

$2,000 - $2,500

$3,000 - $3,500

$4,000 - $4,500

$5,000 - $5,500

$6,000 - $10,000

$15,000+

Please note travel is additional

What effect/impact do you want the speaker(s) to have on your audience?

What is the theme of your event and describe the issues related to your event that the speaker will need to address?

Please list any additional objectives or needs

If you are human, leave this field blank.