Questionnaire

Speaking Survey Questionnaire

1. Your Name: *

Company Name: *

Email Address: *

Phone Number: *

2. Website(optional):

3. Please provide the name, date and location of the event (Must be at least 6 months out)

Name of Event: *

Date of Event: *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

4. Please describe event: *

5. Please provide length of time you would like Shaun to speak: *30 mins-1 hr1 hr-2 hrsover 2 hrs

6. What would you like your attendees to take away from this event? *

7. Please describe your audience demographic (i.e. age, geographic region, psychographic profile, etc): *

8. What is your speaking budget range? *$0-$200$200-$500$500 and up

9. Is this your first time hosting this event? *YesNo

9a. If no, how many attendees did you have at the last event? *

10. How many attendees are projected to come? *

11. Please describe your marketing plan to fill the event: *

12. Are you selling products or programs at the event? *YesNo

13. Will we be able to sell our products and programs at the event? *YesNo

Please do not fill in this field.

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