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:

Desire Speaking Topic(s):

Custom Topic (please describe):

Preferred Duration:

Presentation Format:

Other (please describe):

Will audio/visual equipment be provided?

Is travel and accommodation covered (if in-person)?

Dress Code / Event Tone:

Other (please describe):

Speaking Budget Range :

Would you like to use the speaker's name, image, or biography for event promotion ?

Will the event be recorded or live-streamed ?

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.

How did you find out about our services?

Payment Methods

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

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

Signature