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Speaker Request Form
Please complete and submit this form to request Lucy as Speaker at least 30 days prior to the date of your event
. Her goal is to respond within 24 to 48 business hours upon submission of this form.
Your Contact Information
*
Indicates required field
Contact Name
*
First
Last
Position
*
Phone Number
*
Email
*
Organization
*
Organization Website
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Program Description
Date & Time of Program
*
Theme or Purpose of Program
*
Time of Speaker's Presentation (plus length)
*
Language Preference of Speaker Presentation
*
English
Spanish
Bilingual: English & Spanish
Approximate Size of Audience
*
Describe your Audience and what you'd like them to takeaway from presentation.
*
Event Location & Address
*
Line 1
Line 2
City
State
Zip Code
Country
Additional Information You Would like to Note
*
Equipment and A/V Available for Speaker Use
Check those available
*
Projector for PowerPoint
Screen
Microphone
Flip Chart, Easel, Markers
Presenter Work Table
Extension Cords
None available
Specifics of Event
Is this an annual event?
*
Yes
No
What is your Speakers Budget?
*
Which of these apply to your event?
*
It will be videotaped.
It will be audio recorded.
There will be media coverage.
None apply to event
Name of Airport Closest to Event
*
Speaker Fee Information
Presentations are Fee Based
plus
Travel Expenses.
Final confirmation made once a contract or agreement is initiated, completed & signed by both parties.
Name of Person to be Invoiced
*
Phone Number
*
Email Address for Invoice Purposes
*
Note
:
If you do not have a Speaker's Budget, Ms. Cantú offers a
limited
number of speaking engagements yearly for an Honorarium and travel expenses. Please submit this completed Speaker Request Form and explain the special circumstances of your organization for consideration. We will contact you with response.
Explanation:
*
Submit
Home
About Lucy
>
Spiritual Aspect of My Work
My Wake-Up Call
Coaching
Workshops & More
>
Lucy in Action: Videos
Earth Angel Collaboration
Speaker Request Form
Blog
Contact
Página en Español