Speakers Bureau

Today’s date:

Name of company or organization:

Your Name:(Required)

Your Phone:

Your Email:(Required)

Will you be the contact person?

Yes

If “no”, please provide contact person’s name:

Type of event (e.g., conference, seminar, luncheon):

Event name (if applicable):

Desired speaker topic:

Anticipated audience (e.g., academic, health care professionals, consumers):

Estimated audience size:

Desired length of speaker presentation:

Date and time of presentation:

Location of presentation (include specifics like street address, floor number or room name, etc):

Parking instructions for speaker:

Can you pay travel expenses if necessary?

Yes

Can you pay honorarium if necessary?

Yes

If “yes”, amount of honorarium:

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If you have questions, please contact:

Ryan Johnson
Executive Director, Lifelong Learning,
College of Global Futures
480-965-2976
[email protected]