Name

Title

Organization

Phone Number

Email

Title, Date, Time & Location of Your Event (If your date is flexible, please share date options for consideration)

What type of presentation are you requesting? What type of presentation are you requesting? Keynote Workshop Panel Training/Facilitation Virtual Presentation Interview Other (Please explain in note area)

What type of presentation are you requesting? What type of presentation are you requesting? 1-2 Hours Full Day Half Day Multi Day Other (Please explain in note area)

Is this a first-time event? Is this a first-time event? Yes No

If no, please briefly describe the event history?

Please describe your event audience and number of expected attendees?

What does success look like for your event (share desired outcomes).

What is your Speaker Budget? (Please explain in detail, taking into consideration that Tamara Rochelle's Speaker Rates start as follows: $10,000+ for Corporate Engagements, $7.500+ for Non Profit Engagements, and $2,500+ for Honorariums, plus travel and accommodations.

If you do not have the capacity to cover her standard fees, are you able to cover her round trip travel and accommodations to support your event? If yes, please provide proposed options.

If you do not have the capacity to cover her standard fees, are you able to cover her round trip travel and accommodations to support your event? If yes, please provide proposed options.

Are you interested in purchasing bulk copies of Tamara Rochelle's books or products for participants in advance of this engagement? Are you interested in purchasing bulk copies of Tamara Rochelle's books or products for participants in advance of this engagement? Yes Possibly, let's discuss Not at this time

If yes, please select products you are interested in. If yes, please select products you are interested in. Become an ACTOR Book Stop Wasting Your Time Blaming Others for Your Life Book and Journal Too Brilliant to Be Broke Audio Masterclass Take Action Academy Access Take Action Bundle Daily Action Journal

Will the event be recorded? Will the event be recorded? Yes No

Will Tamara Rochelle have the opportunity to sale her products and services at the event? Will Tamara Rochelle have the opportunity to sale her products and services at the event? Yes No

Please share any additional notes/details about your event.