Speaker Request First Name Last Name Email Address Phone (please format xxx-xxx-xxxx) Who would you like to speak at your event? Who would you like to speak at your event? Nathan Pierce Betsy Pierce Jennifer Avila Nathan & Betsy Pierce Nathan Pierce & Jennifer Avila Are you the event coordinator? Are you the event coordinator? Yes No Event Coordinator's first name Event Coordinator's Last Name Event Coordinator's Phone Event coordinator's email Do you already have a date for your event? Do you already have a date for your event? Yes No Please give approximate idea when your event may take place Vision or purpose of the event Location of the event (Address, City, Zip) What technology will be available for our speaker? (select all that apply) What technology will be available for our speaker? (select all that apply) Projector & projector screen Macbook/PC None Other What other equipment will be available? What kind of event is it? What kind of event is it? Conference Homeschool group meeting High school graduation Online event Other What kind of event will this be? Type of organization hosting the event? Type of organization hosting the event? Homeschool group Church Other Group/organization name Group/organization website (enter "none" if not applicable) What time should speaker(s) arrive at the event? What topic(s) would you like Nathan to address Is this a multi-day event? Is this a multi-day event? Yes No Please enter start and end time(s) for EACH day of your event When would be the FIRST day of speaking? When would be the LAST day to speak? How many sessions would you like Nathan to speak? How many sessions would you like Nathan to speak? 1 2 3 4 or more How long should the speaker speak for in each session? How long should the speaker speak for in each session? 30 min. 45 min. 1 hr. More than 1 hr. What time should Nathan arrive for each session? Who will be invited to attend specifically? Who will be invited to attend specifically? Homeschool Leaders ONLY Parents ONLY Parents & Children Leaders & their families Christian Private Homeschoolers Mix Christian/Secular Private Homeschoolers Other Please list attendee type List homeschool group(s) that'll be asked to attend the event. Will there be an opportunity during the event to meet with just the leaders? Will there be an opportunity during the event to meet with just the leaders? Yes No Approximately how many attendees do you anticipate attending, not including children? Approximately how many attendees do you anticipate attending, not including children? 25-50 51-100 101-125 126+ Is there a reservation system in place so that you can anticipate how many people are coming ahead of time? Is there a reservation system in place so that you can anticipate how many people are coming ahead of time? Yes No Select 2-3 ways in which attendees will be recruited for the event? Select 2-3 ways in which attendees will be recruited for the event? Social Media E-mail Physical Mailings Phone Website Has promotion of the event already started? Has promotion of the event already started? Yes No What materials will be used to promote the event? What materials will be used to promote the event? Flyers E-mail Posters Other What materials will be used to promote the event? If you have your own material to promote the event, will you send us the material(s) so that we can promote the event as well? If you have your own material to promote the event, will you send us the material(s) so that we can promote the event as well? Yes No Will there be a table/booth where speaker can present FPM materials? Will there be a table/booth where speaker can present FPM materials? Yes No What airport(s) are near the event? What airport(s) are near the event? LAX ONT (Ontario Intl.) SAN (San Diego Intl.) SNA (John Wayne) Other Please list airport(s) What is the travel time from the airport to the event? Which travel expenses will you/your group be able to cover? Which travel expenses will you/your group be able to cover? Airfare Airport Transport Rental Car Fuel Lodging Meals None Other List any additional travel expenses not listed Can either of the following be taken during the event? Can either of the following be taken during the event? Honorarium Offering taken during event Both None Additional Comments? Let's Get Nathan Booked!
