Name

Email

Phone Number

Event Coordinator Name

Event Coordinator Email

Event Coordinator Phone Number

Event Start Date

Where is the event located?

What is the name of the event?

Event Website URL

What organization is sponsoring the Event?

What is the vision, purpose, and audience of the Event?

Is this event open to the general public or by invitation only?
—Please choose an option—General PublicInvitation Only
Who are the other speakers (if any)?

How many attendees do you expect?

How many times would you like Bob to speak?

How long should Bob plan to speak for each message?

What specific topics are you requesting he cover?

Do you agree that your organization will cover all expenses for Bob Thune plus an associate?
—Please choose an option—YesNo
If no, please explain:

Honorarium Amount:

When do you need a formal commitment from Bob Thune?

Additional Comments/Questions

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