SPEAKING ENGAGEMENT REQUEST
Please complete the speaking request form in its entirety, providing as much detail as possible.
First Name
Last Name
Name of Organization
Organization Type
Select an option
Non-Profit
For Profit
Contact Number
Email
Type of Event
Purpose of Event
Event Start Date
Event Start Time
Event End Date
Event End Time
Location of Event
Topic of discussion
Will Rochelle be speaking once?
Length of time you would like Rochelle to speak?
COMPENSATION FOR ROCHELLE:
Please answer the below inquiries regarding compensation.
Are there any expenses included if event is not local to Austin, Texas (within 60 mile radius) NA if event is within 60 miles of Austin, Texas.
Budget / Compensation - based on travel accommodations, length of speaking, engagement/questions after events dining etc, 1:1 consults etc
Please choose one of the following.
Up to $250
Up to $500
Up to $750
Other arrangements and accommodations. Please explain below
Please provide any additional information pertaining to compensation and/or other arrangements
Is there a required attire/theme/color
Yes
No
If there is, please provide details below
What type of discussion / platform / forum will Rochelle be presenting on?
Individually
On a Panel
Other
If other, please provide details below
Is this a free event or will there be ticket sales?
It is a free event
There will be ticket sales
How many people are expected to attend?
Is speaker allowed to advertise her own products/services at event?
Yes
No
If yes, is there a fee?
Will there be presentation equipment? If so, please provide specifics below
Will speaker need to provide you any documents, bio etc. prior to event?
Upload Document with information about the event (if applicable)
Select a File
Additional information or expectations of speaker.
Submit
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