Jimenez Bailey

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Complete the form to book Jimenez for a speaking engagement.

You may also contact Jimenez toll free at 1-888-565-3318, to book Jimenez for a speaking engagement.

Name***		Organization***

Address

City		State / Province / Region

Postal/ZIP Code		Country

Phone Number***

E-mail***

Requested Topic

Date of Event ***

Time of Event

:	:
HH	MM	AM/PM

Location of Event ***

Approximate time Jimenez would deliver remarks?

Length of Speaking Time?

Format ***

AV Requrements: Cordless lavaliere microphone, PP projector and screen

Please tell me a little about your organization:***

What is your company's major strength?

What are the three things you want people to remember when Jimenez's presentation is completed?

What takes place immediately before and after the program? (Please send program outline if possible)

What are some current problems/opportunities, breakthroughs occurring in your organization?

What are the most important challenges faced by the people who will be in the audience?

What did your group like or dislike about speakers in the past?

What speakers did you have in the past?

What other speakers are speaking at this event?

Are there any issues that should be avoided?

Speaker dress attire for the event.

Are there any special functions that would be helpful to attend? When and Where? Dress attire for function?

Number of Anticipated Attendees

Average age of group?

Male/Female Percentages

Speaker Honorarium Budget

Is there anything else?