paNASH Speaker Request Form Survey

Thank you for contacting paNASH!

Owner and expert career coach Lori Bumgarner provides a no-frills speaking style with tangible take-aways that can be applied to each audience member’s career stage.

The Amazon #1 bestselling author of two books, Lori has been praised for her interactive exercises and unique “nuts-and-bolts” how-to instruction on being competitive in today’s world of work.

Please complete the following form to request Lori to speak at your next event.

Once your form has been completed, we will be in touch with you within 2-5 business days to let you know of her availability and to discuss her speaker rate and any additional necessary details.

Please note: not every request can be filled. First consideration will be given to those requests that meet a certain criteria.

1.Contact information:(Required.)

First AND Last Name:

Organization Name:

City and State:

Email:

Phone:

How did you hear about us?

Would you like to receive the paNASH newsletter?

2.Please indicate your organization type:(Required.)

Corporation

Professional Association

Non-profit 501(c)(3)

Other (please explain)

3.Please indicate your organization's budget for speaker fees (include travel/lodging expenses if applicable).(Required.)

4.Please choose a general topic or topics of interest (select all that apply):(Required.)

If you have another topic in mind, please provide details of what you're seeking, including preferred learning outcomes. NOTE: additional fees may apply for topics requiring additional research and prep time.

5.Please indicate the location of the event, and provide three potential engagement dates. (Note - if you're requesting dates during the winter months, please provide in parentheses for each choice a possible backup date in the event of inclement weather).(Required.)

Location/venue:

Date(s):

6.Please indicate the approximate or desired duration of presentation:(Required.)

7.Please indicate the following:(Required.)

Estimated # of attendees:

Is attendance required?

If no, is an RSVP required?

Do attendees have to pay a monthly membership fee or an event fee to attend?

8.Please describe in detail the typical demographics of the potential audience including age, gender, current job status (i.e. employed, employed but seeking, unemployed, etc.), stage of career (i.e. early, middle, late), etc.

(Required.)

9.Will Lori be allowed to promote her services or products in the conclusion of the presentation?(Required.)

Yes, Lori can promote her services and materials to audience members, within reason.

No, we do not allow speakers to promote their business or services.

10.Please provide any additional details related to your request.