Speaking Engagements Paid Speaker Request Form Appearance and Speaking Engagement Request Contact Information Full Name * Title * Institution/Organization * Website * Email * Phone * Event Details Event Name/Theme * Event City * Event State * Event Date * Event Date(s) * If your event is more than one day, please list the dates below. How would you like Dr. Scott to attend? * In-Person Virtual What time are you requesting Dr. Scott to attend? Please include start and end times. * Requested Event Attire * Business Professional Business Casual Casual Other If other attire, please list. What is the group’s objective in having Dr. Scott to speak? * Please select the speaking engagement request. You may select multiple. Keynote Commencement Address Book Club Session Workshop (60 mins or less) Workshop (90 mins or less) Workshop (over 90 mins) Another Type of Speaking Engagement If it’s another speaking engagement request, please list. Should the remarks be formal or conversational? Formal Conversational Does the group have any special interests, topics or concerns that should be addressed? Anticipated number of attendees? Is there anything else that you would like for us to know about your event? Travel Details/Arrangements What are the guidelines for travel budget and arrangements? Will you handle travel arrangements? Yes No Onsite event contact name and cell phone number Other notes Upon selecting submit, you will be contacted by Dr. Scott’s team within 48 business hours using the contact information provided on the request form. Thank you! If you are human, leave this field blank. Submit Δ Support this message:TweetEmailMorePrintShare on TumblrPocketTelegramWhatsAppLike this:Like Loading...
