Dr. Becky Bailey's Loving Guidance

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Speaking Engagement Request Form

Dear colleague,

The following information worksheet must be completed by you and returned via fax or email within 5 days. We need this information as soon as possible to evaluate your request for potential scheduling. Thank you.

Event Information:

Hiring Party:
Requested Speaker:
Topic:
Proposed Date:
Location (city & state):
Speaking site:
Address:
Closest Airport:

Type of event:

	Keynote - Opening or Closing Keynote? Opening Closing
	Parent Night
	Breakout - Same group of people? Yes No
	Workshop - 1/2 Day Full Day

*A Featured Speaker?

Yes No

Would anything be running simultaneously with the talk?

Yes No

Event Forum:

Breakfast Lunch Dinner None

Type of Audience:

Is this a ticketed session?

Yes No

Is attendance at this workshop mandatory?

Yes No

Estimated number in attendance:

Start time:

End Time:

Time Zone:

Contact Information:

Name:
Mailing Address:
City, State Zip:
Phone Number:
Fax Number:
Emergency Cell:
Email Address:

Lodging Information:

Name of recommended hotel:
Distance from hotel to airport:
Distance from hotel to speaking site:
Hotel Phone Number:

Transportation:
How will transportation be provided:

From Airport to Hotel:
From Hotel to Speaking Site:
From Speaking Site to Airport:

Travel Time:

	From Airport to Hotel:
	From Hotel to Speaking Site:
	From Speaking Site to Airport:

Additional Info:

Thank you for your time,

Elaine Torma
Loving Guidance, Inc.
Elaine@lovingguidance.com