Request Services Form
Request Services Form
Name of Organization:
*
Event or Service:
*
Location (City and State):
*
Event Date(s):
*
Target Audience
Expected Attendance:
Describe what you are requesting of Cheryl, e.g., Tour event, Keynote speaker, Emcee, Broadcast consulting:
Number of Presentations:
Please give us a brief history of this event, i.e., purpose, previous speakers, past attendance:
List guest speakers who have participated in past conferences/events:
Background information on the inviting organization:
Organization Phone Number:
*
Organization website:
Your Name:
*
What is your role with planning the event?
*
Decision Maker
Event Planner
Committee Member
Interested Party
Other
Your Email Address:
*
Your Phone Number:
*
Best time to contact:
Will Cheryl be able to sell her books, tapes, and products at your event?
Yes
No
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