EVENT REQUEST To request Bobby to speak at your event, please complete the form below. Name of Event Name of Organization Date of Event (mm/dd/yyyy) Event Start Time (hh:mm AM/PM) Event End Time (hh:mm AM/PM) Event Location Street Address Event Location City Event Location State (XX) Event Attire Black Tie Business Business Casual Other Purpose of Event Audience Details Who will be attending? Will there be any guesst that Boby should be aware of? Is there a speaker budget for the event? Yes No Estimated Attendance Is the Event Open to the Press? Yes No Livestream/Online Yes No Will the event be livestreamed or posted online? Event Point-of-Contact First and Last Name On-site Point-of-Contact First and Last Name If main event POC will not be present, please enter name of on-site POC. Event Setup Please describe how the event will look (head table, lectern, etc.). Seating Arrangements Please indicate where Bobby will be seated and who will be seated with him. A/V Setup Please describe the A/V arrangements. Bobby's Role Please describe Bobby's role in the event (brief remarks, keynote address, workshop, etc.). Bobby's Introduction Please indicate who will introduce Bobby (name, title, role, etc.). Event Agenda Please provide the event agenda (You can email one to bobbykipper@thekippergroup.com if that is more convenient.). Bio and Headshot Yes No Will you need a bio and headshot of Bobby? Email Address for Bio and Headshot To what address should Bobby's bio and headshot be sent? Additional Info What other details does Bobby need to know about the event?