Your Name: *


Your Email: *


Your Specialized Expertise (25 words or fewer):


Web site URL:


Today's Date:


Company name:


Phone:


Cell phone:


Street Address, City, State/Province and Postal Code for mailing:


How did you hear of Andrea Reynolds International?


What year did you start getting paid to speak to audiences?


What year did you first start speaking to audiences (paid or free)?


What's the largest fee you have received for a keynote presentation not including product sales? (This won't be published.)


What percentage commission would you be comfortable giving Andrea from your speaking fee for her work on your behalf?
50% 40% 30% 25% 20% 15% 10% Something else

Past audiences you have addressed (specific names):


Awards received:


Languages you can speak fluently:


Briefly tell why this niche/specialized expertise is your passion, how you got started:


Your bio for the meeting planner's programme brochure, introduction:


Titles of your books, CDs DVDs, etc., that you could sell at events (Send me copies if you want me to read/review it/them on several websites: PO Box 9124, Erie PA 16506):


List of your lecture titles and description (Word file or PDF):


List of your seminar and workshop titles and description (Word file or PDF):


List of Desired Audiences (be specific, name them):


Testimonials and evaluations from past audiences (Word file or PDF):


Specific policy and contract terms beyond the ordinary:


Include photo #1 such as your head shot:


Include photo #2 such as your book cover:


Please provide links to videos (YouTube, etc.) that show you speaking to audiences:


If you don't yet have demo videos to show, please provide links to your guest appearances on TV:


Preferred speaking fees (This won't be published.):


Lowest acceptable speaking fees. (This won't be published):


Do you use a written contract? Check for YES, leave blank for NO:

Please share a copy of your last written speaking agreement (This won't be published.)


What about negotiating bigger speaking fees yourself is uncomfortable or difficult for you?


Do you want Andrea to negotiate better speaking fees and contract terms for you? YES or NO?


If you're unsure about having Andrea increase your fees, kindly state your reasons and/or concerns:


Are you willing to allow Andrea Reynolds to handle and negotiate ALL your speaking inquiries and invitations EXCLUSIVELY (no exceptions) for a period of one year? YES or NO?


May I have your permission to post some of your answers (excluding fees) on your own page profile on AndreaReynolds.com? YES or NO?


Have you remitted your $99 annual listing fee for your unique speaker page on AndreaReynolds.com, by PayPal?
No Yes I'll send a check by mail to Andrea Reynolds, PO Box 9124, Erie PA 16506.