Speaking & Facilitation Inquiry Form

First Name

Last Name

Name of group or organization

Position Title

Phone Number

Event Name

Preffered Method of Contact

Date & Time of Event

Location (if virtual, please write: VIRTUAL)

Expected Audience Size

Duration of Engagement

1. Describe the theme or topic of the event. What is the primary goal or purpose of the event?

2. Who is the target audience for the event?

3. Do you require a keynote speaker, workshop facilitator, panelist or other role?

4. Are there specific topics or content areas you want the speaker or facilitator to address?

5. What outcomes or takeaways do you hope to achieve from the speaking or facilitation engagement? Are there specific learning objectives?

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