Request A Speaking Engagement with Frankie

Please complete the form below

Requested Date

What date would you like Frankie to come and speak?

YYYY

Presentation Time

Total time allowed to speak. i.e. 30 minutes, 1 hour, etc.

Type of Speaking Event

Check all that apply

Audience

Audience demographic profile

Audience Size

Location of Event

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Section 2

Material Information

Will the display and sale of materials be permitted? (If no, please go to the next section)

Address to Ship Materials

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Person

First Name

Last Name

Name of Organization

Phone

(###)

###

####

Alternate Contact (if applicable)

First Name

Last Name

Phone

(###)

###

####

Section 3

Is there an honorarium?

If yes, please provide the amount.

Name of person assuming financial responsibility

First Name

Last Name