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Book Malika to Speak

Organization Name *

Organization Type *

For Profit
Non-Profit

Organization Address *

Organization Phone Number *

Organization Website *

Contact Name *

First

Last

Contact Work Phone Number *

Contact Cell Number

Contact Fax Number

Contact E-mail Address *

Contact Mailing Address *

Speaker Budget including Honorarium *

Name of Event *

Date of Event *

mm-dd-yyyy

Time of Event *

Length of Presentation *

Please provide an outline or program for the event.

Is the event virtual or in-person? *

Virtual
In-Person
Unsure

If the event is in-person, please provide the exact address of the venue.

Room Type *

(e.g. Auditorium, Classroom, Gym, etc.)

How will the room be arranged? *

Will there be decorations? Please provide details on the theme and colors. *

Goal of Event *

What topics would you like addressed? *

Will the event be recorded?

If yes, will recordings be available? How?

Malika may need a large screen, projector, full PA, sound system, and reliable internet. Are these audio/visual accommodations available? *

Yes
No
Unsure

Activities Requested

Got Manners? Inspirational Speaker
Host / Moderator
Book Club Meeting / Book Signing
Workshop / Conference Session
Panelist / Judge

Please check off your needs

Number of Expected Participants *

Age Range of Attendees *

Please provide some audience demographic information. *

(Occupations, ethnicity, education, etc.)

Is the event open to the media? *

If the event is in-person, is transportation to and from the event provided for speakers? *

If the event is in-person, is it possible for Malika Williams to arrive 60-30 minutes prior to the event to set up her laptop and presentation to ensure all is running smoothly? *

What is the attire for the event? *

If the event is virtual, on which platform will the event be held? *

If the event is virtual, will there be a tech rehearsal? *

Please note any questions or comments you may have:

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