Speaking Engagement Intake Form

Speaking Engagement Intake Form
Name

First NameLast Name
Organization/Company:
Job Title:
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Website (if applicable):
Event Name:
Event Date (s)
Event Location/ Platform (in-person or virtual):
Expected Audience Size :
Audience Type (eg. students, employees, entrepreneurs)
Event Theme or Focus:
Leadership & MindsetOvercoming AdversityMotivation & ProductivityPersonal GrowthTeam BuildingCustomer Service
Custom Topic (please describe):
15-30 minutes30-60 minutes60-90 minutesHalf-day workshopFull day event
Keynote AddressWorkshop /Interactive SessionPanel DiscussionQ & A Session
Other (please describe):
yesno
yesno
FormalBusiness CasualCasual
Other (please describe):
Speaking Budget Range :
yesno
yesno
If Live-streamed (please specify distribution plans):
Please share any goals, expectations, or special request for the motivational talk:
AGREEMENT/REMINDERS:

I understand that all information I entered in this form will be considered strictly confidential.

The data gathered from this form will only be used as a basis for the type of coaching the client will need.

I understand that in order to be successful, it is vital to follow the plan agreed by both the life coach and the client.
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My Products*

Nonprofit Speaking Event

$500 – $2,500 per event

Local schools, churches, nonprofits

Short talks (30–60 minutes)

Virtual or local travel only

$500.00 Quantity

Corporate Speaking Event

$3,000 – $10,000 per event

Corporate events, conferences, leadership retreats

Audience size: 100–500+

Specialized topics (leadership, resilience, DEI, sales motivation)

$3,000.00 Quantity

Fortune 500 Speaking Event

$15,000 – $50,000+ per event

Fortune 500 companies

National conferences

Often bundled with workshops, books, or consulting

$15,000.00 Quantity

Total

$0.00

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