Fee Request Form
To request Amanda and determine Amanda’s speaking fee for your engagement, please complete the following form. Amanda will contact you within five business days.

CONTACT INFORMATION

Name/Representative:
Company/Organizatioin:
Title:
Billing/Mailing Address:
City:
State:
Zip:
Office Phone:
Fax Number:
Cell Phone:
Email:

EVENT INFORMATION

City Location of event:
Type of event:
Date of event:
Approx. number of Attendees:
Speaking time (Start to finish):

Check a presentation type:
 Keynote Address
Full Audience Motivational Presentation
Breakout Session

Extra Speaking (extra fee):
 No extra speaking
at Breakfast
at Lunch
at Dinner

What is your budget for speaking at this event?
What is the purpose of this meeting?

CONFIRMATION INFORMATION

Please confirm, fax and email Amanda's speaking quote to:
Above Contact
Below Contact
Both
Name:
Fax:
Email:

Additional Comments/Questions for Amanda:
      Why Amanda?
      Initial Booking             Request
      Fee Request
      Pre-event             Questionnaire
      Contract Download
      Contact Amanda
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