STERLING SPEAKERS BUREAU - Professional Speakers Bureaus & Meeting Planning Resource

ON-LINE SPEAKER REQUEST FORM

Contact Person:

Phone:

E-mail address:

Company/Association:

Title:

Address:

City: State/Prov: Zip:

FAX:

Date of Event (or potential date): Time (Speaker is Needed:)

Name of Event:
Purpose of Event:

Event Location:
City: State/Prov:

Hotel/Event Facility:

Speaker Format(s):
Opening SpeakerKeynote Training Workshop
Breakout Seminar Closing Speaker

Length of Speech:

# of Speakers Needed:

Speech Topics Needed:

Speaker(s) you may already be interested in (from either our
website or a specific speaker that you would like us to locate):

# Of Attendees:

Description of audience (sales reps, Board of Directors, etc.):

What do you want attendees to get from the presentation:

What budget range do you want to stay within:

What is your role in planning the event:

Please tell us how you found us:

Deadline:

Additional comments:

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It is our passion and purpose at Sterling International Speakers, Inc. to assist you
in creating a dynamic and unforgettable event for your organization!

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Sterling International Speakers, Inc.
611 North Elmhurst Road
Prospect Heights IL 60070 USA
VOICE: 847.577.5000
FAX: 847.577.5005
speakers@sterlingspeakers.com
Toll Free in US & Canada:
877.226.1003

speakers@sterlingspeakers.com