Dr Gardner's Speaking Engagment Contact InformationName and Title of the authorized person signing the agreement(Required) Contact Person's Phone(Required)Contact Person's Email(Required) Is the authorized person also the onsite and logisitic contact?(Required) Yes No Name, Phone Number, and Email of Onsite and Logistic Contact(Required) Organization and Company Name(Required) Organization or Company's Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Brief Description of your organization or company(Required)Event and Presentation InformationEvent Title(Required) Presentation Date(Required) MM slash DD slash YYYY Presentation Length(Required) Presentation Start time(Required) Program Format: (i.e. Keynote Speaker, Moderator Q&A, Photo Opportunities, and/or Booking Signing)(Required)Audio Visual RequirementsAudio visual check time (usually speaker prefer a AV check as close as possible to their presentation)Wireless lavaliere microphone with fresh batteries needed?(Required) Yes No Presentation clicker available, if presentation is being given?(Required) 4:3 Standard 16:9 Widescreen N/A Slide Format:(Required) Yes No N/A Will the presentation be recorded/live stream?(Required) Yes No Event Location and Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Brief description of presentation theme/expectation for speaker's presentation(Required)Type of event and overall goal/purpose:(Required)Estimated number of people who will attend presentation:(Required) Audience composition: (i.e. title, age range, gender, profession experience, etc.)(Required) Sensitive issues that should be avoided?(Required) Other speakers speaking on this date(Required) Add RemoveIf none, then place n/a. You can click + to add more than one.Past speakers who have spoken for your group and/or at this event(Required)Speaker NameYear Speaker Spoke Add RemoveIf none, then place n/a. You can click + to add more than one.Appropriate Speaker Attire (i.e., Formal, Semi-Formal, Business, Business Casual, etc.)(Required) Marketing MaterialPlease send Dr. Gardner a copy of all promotional material and announcements to be reviewed by his team prior to distribution.Will Dr. Gardner have an opportunity to sell material on-site and/or do a book signing?(Required) Yes No Will a table be made available for book selling/signing(Required) Yes No Address to mail material for the book signing/selling(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code TravelHow would you like to handle the travel arrangement?(Required) Dr. Gardner Client Dr. Gardner (Flight and Ground) and Client (Accomondations and Ground Transporation) Usually Dr. Gardner will book flight and ground in the home city and the client will book accomondation and ground transportation in the host city.Dr. Gardner and team reserve the right to send appropriate airlines, accomondations and ground transporation.If an emergency occurs on the way to the site, who would be an alternate contact if you are not available? Name and phone number(Required) Are there any other special times commitments request in the addition to the speaking engagement? (i.e. VIP Meet and Greet, Media Interview, Book Signing, Receptions, etc)(Required) Please detail as specifically as possible the potential times, locatons, and people attending any extra activities.(Required) Why we can not promise Dr. Gardner will agree to any specific request, we are happy to inquiry on your behalf. Any additional activities must be confirmed by Dr. Gardner and included in the official speaker agreement.Marketing TrackingFor our marketing tracking, please let us know how you heard about Dr. Gardner?(Required) Are you human(Required) Unsure No Yes NameThis field is for validation purposes and should be left unchanged. Dr. Tyshawn Gardner Ministries and Consultant (205) 433-9020 About Speaking Events Shop Gallery Contact Follow DrTyshawnGardner@gmail.com Copyright © 2024 Dr. Tyshawn Gardner. All Rights Reserved. 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