Speaking Inquiry

Thank you for your interest in Pat E. Perkins as a speaker for your upcoming event!

We have just a few questions that will help us learn how we can best serve you. Upon receipt of your inquiry, my Speaking Coordinator will be in touch with you within 48 business hours.

I appreciate your interest and look forward to the possibility of us working together. Thank you for your request … Pat


Contact Name *

Conference, Company or Organization Name *

Mailing Address *

Best Phone Number to Reach You*

Email Address *

Event Date

Event Time

Event Location

Event City

Event State

Approximate Audience Size

Audience Profile

Age Range



Is this an annual event

How many years has this event existed?

Are there other speakers?

If so, whom?

Will there be media coverage?

Will this event be videotaped?

Will this event be audio recorded?

What are you requesting Pat to do? (Keynote, Retreat, Special Event, Panel Discussion, etc.)

How long would you like for Pat to speak?