Speaker & Event Moderator Request

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Speaker / Event Moderator Request
I'm excited to learn more about your event. Please share key details to ensure my team and I are equipped to best meet your event needs.
Your Name*
First Last
Company*
Job Title*
Company Email*
Company Phone*
Company Website URL*

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Event Information Cont.
Event Type*
Proposed Topic/Panel Discussion
Proposed Length*
Will a speaker/moderator preparation room be available?*
Rehearsal Date
Rehearsal Call Time*
Call time for general and technical prep in order to test audio and visual elements and arrange for Erica Nicole to rehearse in the space before the event.
Presentation Talk Time*
If the presentation time is one hour from 9 am - 10 am, talking time will be 40 minutes (15 minutes for questions and 5 minutes for interruptions and delays).
Audience Size (Est.)*
Audience Type (Demographics)*
Is the event open to the press?*
Will the event be broadcasted?*
Will the event be taped?*

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Event Information Cont.
Honorarium – Speaker & Moderator Fee Budget*
Honorarium refers to payment to an individual speaker or event moderator in recognition of special services rendered. This fee/payment does not include travel/lodging and travel-related expenses.
Is travel and lodging provided?*
Travel and lodging includes pre-paid round trip airfare, ground transportation to and from airport (and speaking venue, when applicable), meals and hotel accommodations.
Audio/Visual Equipment
Please select all applicable Audio/Visual Equipment available on-site. Erica Nicole uses her personal laptop and wireless presentation clicker during conferences and keynotes; she also brings a copy of the presentation on a USB flash drive.
- Lavalier (Lapel) microphone
- Screen and Projector
- VGA adapter (for laptop)
- Audio cable (for laptop)
- Surround Sound Speakers (for Audio/Video)

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Event Information Cont.
Additional Comments
How did you hear about Erica Nicole?*
Event Agenda / Schedule (Optional)
Please feel free to share any additional information to help familiarize me with your organization and/or event.
Drop files here or
Next Steps
Upon receipt a member of my team will follow-up within 24-48 hours. Thank you for sharing this opportunity. I look forward to contributing to the success of your next event.
Comments
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Speaker / Event Moderator Request