Pre-Event Questionnaire Waitlist

Please Completely fill out the form below and return to [email protected]

Company/ Organization Name *

Company/Event Website *

1. Contact's Name & Title: 2. Contact's email & phone number *

What is your role with planning the event *

1. Event Description 2. Event Purpose *

Event Location *

Street Address

Address Line 2

City

State

Postal code

Country

1. What is the Date of the Event 2. What Date & Time Would Christine be Speaking: 3. What's the Demographic and Profile of Group(s) to be spoken to: 4. How many people will attend *

What is your Budget? Is travel/lodging included for speaker PLUS on assistant? What is the closest airport? Will ground transportation and meals be provided? *

1. What exactly would you like Erica to do ( Keynote, conference workshop, private business seminar)? Is there more than one appearance requested? What topic would you like her to address? 2. How long would the presentation last? *

Additional comments