First Name*:

Last Name*:


Phone Number*:


Date, time and location of event:

Length of time allocated for Diana to speak:

Number of people anticipated at the event:

What is the budget to hire Diana to speak?

What’s the topic you would like Diana to speak about?

What is the purpose of the event?

Who is the audience? (i.e. age group, professional background, industry)

What do the participants care about? What are their concerns? What do they want to learn more of?

What key messages do you want the audience to take away with?

What do you want the audience walk away feeling?