Speaker Fee
*
Speaker Travel Expenses
*
Organization Name
*
Organization Website
*
Event Contact Name
*
Contact Mobile Number
*
Contact Email
*
Date of Event
*
Event Name/Description
*
Audience Description
*
Speech Topic
*
Speech Length
*
Speech Length
15 min
30 min
45 min
60 min
70 min (Schools)
90 min
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Number of Speeches
*
Proposed Event Schedule (Please include start and finish times for each presentation)
*
Client Notes for Tony (Special Invoicing requests, information about audience/community etc)
Venue Name
*
Venue Location
*
Hotel Recommendations
*
Nearest Airport & Distance
Distance to Venue
Payment Type
*
Payment Type
Credit Card (+3% credit card fee)
ACH (preferred)
Check (due in person or sent certified mail)
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Acknowledgement
*
Recording of speech for distribution is not allowed
Equipment
*
Wireless Handheld Microphone
Client Signature
*
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