Speaking Request

Organizer Name *

Organizer Email *

Organizer Phone *

Title of Event *

Event Date *

Event Time

Event Location *

Expected Number of People in Audience? *

How much time does she have to speak? *

Will Dr. McCauley deliver a Keynote, serve as a Moderator, or be a Panelist? *

What kind of setting will it be? *

What attire is expected? *

What should be the focus of her remarks? *

Will there be time for questions and answers? *

Will there be an opportunity for a book-signing? *

What is your budget for Honorarium? *

What is your budget for travel expenses? *