Speaking Request - Erica Lynn Speaks

Questions? Call 1(586) 307-4518*

Name of Workshop, Seminar, or Speaking Event?

Sponsoring Group?*

Name of contact person*

First Last

Phone Number*

Fax Number

Email*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Meeting Specifics*

Meeting Location

Is meeting date fixed or tentative?

Specific content to be covered?

Specific meeting times

Actual speaking time during each meeting

Number of attendees expected

Median age of attendees

What is the theme for your event?

Honorarium (please write a specific U.S. dollar amount)*

The honorarium check should be made out to 1 Step Beyond U, LLC

Will honorarium be given in advance?

Yes
No

The final day of meetings?

Special arrangements needed?

Overnight Accomodations

Hotel Name

Hotel Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Hotel Phone Number

Logistics

Can you supply (check all that apply)

Any Special needs your organization may have when it comes to logistics

Expenses (Meetings less than 200 miles)

What is mileage from speaker's hometown?

Can you provide a detailed map?

YES
NO

Will auto travel of 33 cents per mile be covered?

YES
NO

Expenses (Meetings more than 200 miles)

(Air travel arrangements will be made by 1 Step beyond U, LLC unless agreed otherwise)

Will air travel be covered in advance?

What is the length of travel time from airport to meeting place?

Who will transport to/from airport?

Person Completing FormUntitled

Name of person completing this form

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number

Email

Fax Number

POSITION/TITLE

NOTE:

Speaker Request Form