PMC

Event Request Form

Complete the speaker request form below to inquire about having Kenny Crosswhite speak at your next event.

Contact Name *

Phone Number *

Email Address *

Event

Event Start Date

Event End Date

Choose Speaker

1. What time will Kenny speak for your group? (include the time of the entire service broken up into starting and ending time and include exact times of events in between)

2. What time to you prefer that Kenny arrives to the place where he will speak?

3. What are the names of the nearest public and private airport? How far is the airport from the place where he will speak?(if not applicable, then directions to event.)

4. Please provide an exact address of the place where Kenny will speak?

5. Please provide audience information (age, background, number of people).

6. Is this service casual or formal? Contemporary or traditional? What is the appropriate attire for Kenny (suit, khakis, robe, etc)?

7. Do you have access to an amplified sound system including a microphone for Kenny to use? Does the system have recording capabilities? Video/CD/DVD capabilities? Power Point?

8. Do you have a general topic you would like to Kenny to cover (general guideline)? What is the approximate length of time for the actual talk?

9. What are the proposed expenses/honorarium amounts for this speaking event?

10. Any additional comments:

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