Speaking Request Form
Thank you for your interest in having me speak at your event! Please fill out the form below to submit a request.

A Little About Yourself

Your Name (required)


Your Email (required)

Your Telephone/Cell Phone Number

Tell Me About Your Organization


Organization Website

Street Addreess

City and State

Zip/Postal Code

Tell Me About Your Event

Event Title

Event Website

Expected Attendance

Please Define Audience Demographics: retailers, educators, politicians, business people, students, etc.

List Other Speakers/Musicians Keynoting Event:

Is there a dress code for this event?

Only, or First, Date Requested for Michael Paul to Speak

Day of the Week

Specific Date/Time When Michael Paul Would Have To Arrive, at the latest

Specific Date/Time When Michael Paul Would Be Free To Leave, at the earliest

Does This Event Include An Honorarium?
 Yes No

Budgeted Honorarium

Will You Cover Travel Expenses?
 Yes No

Will You Cover Travel Expenses for Additional Person(s)?
[check TravelExpensesAddPersons "Yes" No"]

Would You Like To Keep the Travel Expenses to a Certain Budget?

Briefly Describe the Goal or Purpose of This Event

Venue, or Location, of Event

Venue Name

Venue Address

Nearest Airport

Distance of Airport to Venue

Additional Comments/Questions:

Enter Captcha


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