SPEAKER REQUEST FORM
The following form will assist us in considering and preparing for your event. Please complete all applicable information. For questions regarding this form
please call 404-807-7624 or email us at info@DarylFletcherSpeaks.com
Contact Person's Phone #
Contact Person's Email
Emergency Contact - In case Daryl is delayed
How did you hear about Daryl Fletcher and 1 Dynamic Life
Name of Sponsoring Organization
Address of Organization
Address Line 2
Date and time of Event
Describe the nature of event and any specific topics Daryl should cover (Theme, Purpose, Etc)
Are there any sensitive issues that should be avoided?
Number of people expected to attend this event
Will Daryl be able to bring someone from his team to this event
How long will Daryl have to speak?
Date and Time Daryl is expected to arrive?
What is the expected attire for this event (Suit &Tie, Casual, Formal, Informal, Etc)
Will there be access to a screen/blank wall, LCD projected, and or a table in order to use Power Point if neccessary?
Will a representative for 1 Dynamic Life be able to set up an information table (before/after the event) and promote Daryl's resources such as CD's booklets, Books, DVD's etc.
What is the budgeted honorarium for this event?
This is Not A Confirmation
A representative of 1 Dynamic Life will contact you with Daryl Fletcher's availability once we have recieved this completed form. Thank you for your consideration.