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Speaker Request Form
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Contact
*
First
Last
Name of Sponsor Organization or Company
*
Speaker Requested
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Otis Zanders, CEO
Stevenson Morgan, Employment Coach
Kenneth Gary-El, Housing Coach
Darnell Baker, Wellness Coach
Andre Knight, Coach
Roosevelt Mansfield, Youth Coach
Office Phone
*
Cell Phone
*
Email
*
Sponsor Organization/Company Address
*
Address Line 2
City, State, Zip
*
Name of Event
*
Name of Event
Event Date
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Virtual Event
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Yes
No
Virtual Meeting Platform
*
WebEx, Teams, Chime, ZOOM
Venue Capacity
Name of Venue
*
Venue Address
Venue Address Line 2
Venue City, State, Zip
Event Description
Honorarium Offer
*
Name
*
First
Last
By typing your first and last name above, you acknowledge that this is a FIRM offer. If Speaker accepts this offer, a binding contract will subsequently be formed. You represent that you have the requisite authority to enter into such a binding contract. This firm offer form must be filled out and signed by someone with the requisite authority.
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