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Saturday, July 31 2010



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SPEAKING ENGAGEMENT/EVENT PARTICIPATION REQUEST FORM
Thank you for the opportunity to invest into your group. To assist us in serving your needs and representing Champions Unleashed in the best possible fashion, please complete this form as part of any invitation for Ed or one of his speakers to participate at or attend an event or meeting.
 
While we openly accept the vast majority of invitations that are made, we must frequently decline an invitation due to a calendar conflict. Champions Unleashed attempts to accommodate most requests and appreciates your patience and understanding with our calendar.
 
Event Name:
Event Location:
Start Time:
Event Date(s):
End Time:
Speaker participation/involvement
request from:
to:
Please NOTE: The times requested for our participation should be as exact as possible, as Ed or one of our speakers may be expected at multiple locations on the same day if your event is an all day booking. If the event schedule changes after submitting this request, please contact us at 714-995-6900 immediately so we may determine if the change can be accommodated.
Contact Person:
Phone Number:
Address:
Email:
Person to meet our Speaker:
Is the audience internal, external, business,education(students), government,donors,etc. (please be specific):
Number of People Expected in Audience.
Age Range.
Male / Female / Mixed.
Dress code:
Is there a theme for this event?:
History of this event (inaugural, annual, etc.):
Is Ed our speaker being requested to speak?:
(If YES, please answer remaining questions. If NO, then proceed to bottom and submit application.):
Are you able to offer an honorarium?:
If so, what is the proposed amount: $
What is the group's interest in hearing Ed or one of our speakers?:
Does the group have any special interests or concerns that should be addressed?
Is there a topic or subject that should be addressed in our session?
Please submit an official copy of program/invitation (if applicable) at least three (3) days in advance of event to Champions Unleashed.
Preferred length of comments:
Are there people in the audience who should be recognized (dignitaries from group, politicians, donors, etc.)? If so, who?
Are there any other speakers? If so, who?
Enter security code:
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