Speaking Engagement Request, Dr. Tim Ihrig, IMD+A Survey

Requesting Organization

Contact Name

Requesting Organization

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Engagement Location (Event Location)

Contact Email Address

Contact Phone

About the speaking request

Event Date(s)

Event name

Estimated number of attendees

Conference or meeting cost to attendees

Desired length of speech

Budget for speaker fee(excluding travel)

Nearest airport

Ability to present by teleconference if necessary?

Are sessions video recorded?

Are sessions audio recorded?

It this a keynote request or a breakout session?

Keynote

Breakout

Both

How many breakouts will be running concurrently?

Who is the target audience for this session/event?

Other (please specify)

What message are you most interest in Dr. Tim sharing with your attendees?

Please explain your goal for Dr. Tim's appearance.

Speaking Engagement Request, Dr. Tim Ihrig, IMD+A