Speaking Assessment Thank you for booking me to speak at your event! In order to fulfill your request please take a few minutes to fill out the following information. Your Name* First Last Phone*Email* Event LogisticsName of the event:* Brief description/theme of the event* Objective of the event: Name of organization sponsoring event:* Location/Day of Week/Date/Time of event:* This event is:* hour(s) event one-day event weekend event one-week event nonprofit fundraiser Request for:* Keynote/Plenary speaker Panel speaker Breakout session Fundraising "Ask" What is my topic?* How long should I speak for?* What is the anticipated size of the audience? Am I the only speaker at the event?* Yes No How many speakers total will there be? What will the other speaker topics be? Where on the agenda will I be speaking? Can you send me an agenda?* Yes No Not available When available Should I send a bio and pic?* Yes No Bio only Pic only Is the audience paying to attend?* Yes No What is the cost to attendees?* What's your budget for the event? Are travel and accommodations covered?*YesNon/a - event in HoustonAre there networking opportunities before or after the event that I need to plan to attend?* Yes No Event AudienceWhat is the audience age range? (check all that apply)* Teens 20's - 30's 30's - 40's 40's - 50's 50's - 60's mixed What is the audience gender* Men Women Mixed Audience Background/Occupations* How much does the audience know about the topic* Very Little Moderate Amount Have Expertise Mixed How do they feel about my topic?* What is the attire for the event?* Casual Business Formal Other May I talk to a few members of the audience before the event to better understand their common need?*YesNoNot availableIf yes...Contact #1 - name, position, email & phone If yes...Contact #2 - name, position, email & phone Speaker ExpectationsWhy do think I am a good fit to speak to your audience?* When my presentation is over, what information/feeling/action plan do you want participants to walk away with?* What is the biggest issue that needs to be addressed in the talk?* Will there be a Q & A time?* Yes No What kind of questions do you anticipate I will get during the Q & A? How will questions be facilitated? What do you not want me to say on stage? What do you want me to say on stage? State any jargon or acronyms I should be familiar with Technology & Set UpTransporation details* Uber/Lyft Rental car Car service pick up N/A - Local (Houston area) Where should I park when I arrive? Who is my contact when I arrive?* What time is my sound check? Who is the stage technician in charge of making sure things go smoothly before and during my speech? Who will be introducing me? What will happen before I take stage? Event welcome Another speaker Meal Activity What will happen after I take stage? Another speaker Meal Activity Dismiss audience Q & A How will people be sitting?* At tables In rows of chairs At conference table other Please check what will be available at the event location (check all that apply) Wifi Speakers for sound Remote Clicker Laptop Confidence Monitor Will there be a podium* Yes No Will I have a microphone?* Lapel Hand held Attached to the podium None needed Will there be a screen and projector? (for slides)* Yes No Is the screen... Square Wide (16:9) power point Unsure Will this event be filmed or recorded?* Yes, if so I would like the right to use footage No Will this event be photographed?* Yes, if so I would like the right to photos No Who do I contact for photos/video? Δ Contact Me susan.nichols@yahoo.com 281-782-5818 Follow Me
