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DATE:

Check applicable:
Speaker Trainer Athlete Entertainer Author Expert Celebrity
Comedian Other

How did you hear about United Speakers Bureau?

Do you currently work with bureaus? No Yes If yes, please list which ones:
Your full name:
Designations:
Company name:
Address:
Address 2:
City:
State/Province:
Zip:
Country:
Website address:
Email address:
Work phone:
Cell phone:
Fax:
Office manager/personal assistant’s name:
Alternate Phone:



Demos available of your performance: Audio Video You Tube None

Your fees (not what you want, but what you actually get)
Keynote: 1-hour $
Performance $
Typical length
Half-day seminar $
Full-day seminar $
International fees $
Other

Are your fees different for:
In-town programs? No Yes If yes, please explain:


College or Universities? No Yes If yes, please explain:

Non-Profit Organizations? No Yes If yes, please explain:

Any other types of special fees? No Yes If yes, pleas explain:


If the client requested a “satisfaction or money back guarantee on fees only; not expenses.”
Would you participate? No Yes
Tell us your conditions for any such guarantees:


Do you offer any last minute incentives when trying to book your own engagements
No Yes and if so, please describe in detail and then indicate whether or not our
sales staff may offer the same?


Please list below your last 10 speaking engagements by date with the fee you received:
Tell us about your expenses and expense requirements:
Airfare Requirements: Business Coach First Class Unrestricted
How many people?
Out of which airport do you fly?

Accommodations:
First Class examples:

Business Class examples:

Tourist Class examples:

Economy Class examples:

Best available examples:

Safe, clean, comfortable and easy to accommodate examples:
Willing to work with client’s budget


Ground transportation No Yes
Please describe:
Shipping of materials: No Yes
Please describe:
Meals: No Yes
Please describe:
Tips: No Yes
Other describe:

Do you provide handouts or workbooks? No Yes
Do you provide a master at no charge to the client? No Yes
Do you charge to the client for handouts or materials? No Yes
please describe:


Tell us about your presentation style and what past clients have said about
your presentation style:


Tell us about your BACKGROUND EXPERIENCE:
Describe your background. Please include all honors, awards and other recognition.
Please tell us what makes you different and special:

AUDIO/VISUAL REQUIREMENTS: (Check all that apply)
Lavaliere Mic Hand-held Mic Podium Spotlight Sound system
Slide projector Overhead projector Screen Whiteboard & markers
Easel & tablet LCD Panel VCR & monitor DVD player CD player

Other special requirements, please describe in detail:


PRODUCTS:
Video DVD
Price: $ /ea. title:
Price: $ /ea. title:

Audio/ CD
Price: $ /ea. title:
Price: $ /ea. title:

Book
Price: $ /ea. title:
Price: $ /ea. title:

Seminar
Price: $ /ea. title:
Price: $ /ea. title:

Other products:
Price: $ /ea. title:
Price: $ /ea. title:

Our sales department requires that all new speakers submit samples of all their products.

Please select those industries in which you have had formal training, or work experience,
prior to or outside of speaking.



Other:

INDUSTRY FOCUS:
Check the top 3 markets you speak to most often.


Other:


TOPICS:
Please list your topic titles.

Please check your most popular topic areas. Limit 5






Other:


Questions: