Proposal Request form

PROPOSAL REQUEST FORM

Please note that all fields followed by an asterisk must be filled in.

Today's Date*
Today's Date*

When do you need a response for your request?

First Name*
First Name*

Last Name*
Last Name*

E-mail Address*
E-mail Address*

Street Address*
Street Address*

City*
City*

State/Prov*
State/Prov*

Zip/Postal Code*
Zip/Postal Code*

Country*
Country*

Home Phone

Business Phone*
Business Phone*

Fax*
Fax*

Company website

Proposed Delivery Dates:*
Proposed Delivery Dates:*

Program Location(s): City/State or Province

Venue for the Program*
Venue for the Program*

Number of Participants*
Number of Participants*

Budget for Presentation*
Budget for Presentation*

Budget for Materials*
Budget for Materials*

Requested Program*
Requested Program*

Topic*
Topic*

	Innovation and Creativity
	Marketing
	Advertising
	Public Relations
	Direct Marketing
	Sales
	Presentation Skills
	Powerpoint Presentation Skills
	Leadership
	Other

Length of Presentation:*
Length of Presentation:*

Describe program needs:*
Describe program needs:*

Describe who will attend:*
Describe who will attend:*

Current Situation:*
Current Situation:*

For Keynotes: What is the core message your are looking for?

For training: What behavioral change do you want to see?

What Materials do you require?

	Pre-program Questionnaire
	One Sheet for Promotional Purposes
	Press Release for Media
	Biography for the Speaker
	Photo of the Speaker
	Speaker Introduction
	Learning Resources (workbook/handout)
	Post Program Evaluation form
	Powerpoint (before presentation)

Speakers Products

I would like to discuss coaching/consulting for our team

	Delivered Prior to Program
	Delivered After the Program

Travel

	Presenter to Book
	Client will book

Accomodations

	Presenter to Book
	Client will book

Expenses

	Speaker to include with fees
	Bill client after the event

Type of Airfare