SPEAKING REQUEST FORM

Please fill out the form if you are interested in having Eric at your event.

Event Name:(Required)

Event Date:(Required)

For times below, please include mins.

Agenda: Doors Open

Event Begins:

Speaker Begins:

Event Adjourned

Off Premis By:

Requesting Organization:(Required)

Contact Name:(Required)

Phone:(Required)

Email:(Required)

Organizatons Website:

Type of Venue:(Required)

Seating Style:(Required)

Attire:(Required)

Estimated Number of Attendees:

Speech Topic:

Speech Time Allotment:

Option to remote in with Zoom(Required)

Q&A?(Required)

Time Alloted for Q&A:

Speaking Setup:(Required)

Microphone

Podium

Screen/Monitor for Visuals

N/A

Will there be a:(Required)

Photographer

Videographer

N/A

Is Press Invited?(Required)

Who will introduce Eric:

Other Speakers:

Location Address:(Required)

Parking Arrangements: Please choose onsite or fill out instructions to the right

Onsite

Fill out if parking is other then onsite:

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