Speaker Presentation Business Inquiry Contact Information DEH Interiors, NSA Houston Member

www.interiordesignkeynotespeaker.com

Full name Last _______________________________________________ First_____________________________________________________ Title_____________________

COMPANY _______________________________________________________________

ADDRESS __________________________________________________________________________ CITY ___________________ STATE _____ ZIPCODE ____________

OFFICE PHONE __________________ HOME PHONE _______________________

FAX ____________________ CELL PHONE ________________________

E-MAIL _____________________________________________

WEBSITE URL _______________________________________

EVENT INFORMATION

REFERRED BY: ________________________________ EVENT ORGANIZER _____________________________________

CONTACT AT MEETING __________________________ ADDRESS OF MEETING ________________________________________________________

DATE OF EVENT ___________________________________ TIME OF EVENT ___________________ LENGTH OF PROGRAM _________________________

ROOM SPECIFICATION and SETUP ____________________________________________________________________________________________________________________

WHAT IS THE OVERALL THEME OF THE CONFERENCE? ________________________________________________________________________________________________

WHAT TYPE OF EVENT? _____________________________________________________________________________________________________________________________

What IS THE PURPOSSE OF MY TALK? __________________________________ LECTURE ð INSPIRE ð EDUCATE/INFORM ð PERSUADE ð PROVAKE ð

WHAT ARE YOUR MAIN OBJECTIVES ABOUT THE PROGRAM? __________________________________________________________________________________________________________

BRIEFLY DESCRIBE WHAT TYPE OF EVENT YOU ARE PLANNING. WILL THERE BE OTHER SPEAKERS PRESENTING? _________________________________________________________

WHAT ARE THE TOPICS THE OTHER SPEAKERS ARE PRESENTING. ______________________________________________________________________________________________________

YOUR AUDIENCE PROFILE

HOW MANY PEOPLE PLAN TO ATTEND?__________ WHAT IS THE AUDIENCE PROFILE (MALES#, ______ FEMALES#, ______ AGE RANGE OF AUDIENCE, __________ EDUCATION,_________

WHAT IS THE PERSONALITY OF YOUR GROUP? __________________________________ IS THERE INFORMATION I NEED TO KNOW ABOUT THE GROUP? ___________________________________

WHAT ARE THEIR ISSUES AND CHALLENGES? ________________________________________________________________________________________________________________________________

WHAT IS THE BUDGET? ________________________________________________

SPECIAL REQUIREMENTS FROM OUR COMPANY SPEAKER:

EQUIPMENT PREFERENCE: _________________________ POWERPOINT PRESENTATION _____ SCREEN ______ MICROPHONE ________ POWER CORDS _______ PODIUM ________

INFORMATION NEEDED FROM SPEAKER:_________________________________________ TITLE DESCRIPTION OF SEMINAR ________________________________________________________

BIOGRAPHY _____________________________________________ INTRODUCTION _______________________________ HANDOUTS/SUPPORT MATERIALS ______________________________

MY QUOTED PROGRAM FEE AND EXPENSES/PAYMENT STRUCTURE AND OUR POLICY FOR DEPOSITS: __________________________________________________________________________

Approved on Date: _____________________________________________ By:__________________________________________ Contract Sent to: _______________________________________________