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: _______________________________________________