Directory Listing for Event Planners & Organizations Seeking Speakers

Name of your organization:*

Website Link:*

Categories your organization would fit into:

choose all that apply

Categories your organization would fit into:

Please describe:

Meeting location:

Facility name: (Ex: name of restaurant or building name) *if applicable

Address:

Street Address Address Line 2 City State ZIP Code

event_planner_address_street

event_planner_address_line_2

event_planner_address_city

event_planner_address_state

event_planner_address_zipcode

event_planner_address_country

Meeting date(s) and time(s):

Length of presentation:

Contact Person:*

First Last

event_planner_name_first

event_planner_name_last

Title

Contact Title:

Contact email:

Link to Website contact form (if applicable)

Contact phone:

Phone type:

Cell
Office

Texting ok?

Yes
No

About the Organization

Description of your organization:

Description of your audience: (Ex: type of professionals, moms, other, age, gender etc.)

Average/Appx. number of attendees:

About the Presentation

Type of speaker(s) are you looking for: (Ex: keynote, emcee, facilitator, workshop)

Topics of interest to your audience: (please be specific)

Technology available:

Is speaker required to attend the entire function, or just to speak?

Yes
No

About the Speaker

How are Speakers Compensated?

Free only
Honorarium only
Expenses only
Speaking fee paid
Speaking fee plus expenses

Yes, speakers are permitted to: (choose all that apply)

Bring a photographer or videographer to the event included
Set up a back of the room sales table
Share marketing material such as handouts/brochures etc
Receive list of event attendee information and/or email list
Share a special offer with your audience
Send out press releases announcing that they will be speaking to your audience

Additional speaker benefits Include: (Ex: on-site photographer, videographer, meal, accommodations, etc)

Other details about this meeting or organization:

Please provide two images, suggested:

Image one:

Image two:

Are you an active At the Podium Speaker Member?*

Yes
No

Would you like more information about our Speaker Membership, where you can speak to grow your business?*

Yes
No

Name

This field is for validation purposes and should be left unchanged.