Motivational Speaking Request Form

Complete the form below to request a speaking engagement with Florine Mark.


Guidelines for Submitting a Speaking Request for FLORINE MARK

Thank you for your interest in requesting Florine Mark to speak at your event.

Florine Mark receives several speaking invitations each day. To ensure that your request is given full consideration, please follow guidelines and provide all  information as instructed.

Timeliness of Request

Please submit your request as far ahead of time as possible. We suggest all requests be submitted at least eight weeks prior to the event.

Consideration of Request

When reviewing your request, the following areas will be considered:

  • Topic
  • Number of Attendees
  • Travel time, location, and time of presentation
  • Speaker’s Fee

Overnight Accommodations

If overnight accommodations are necessary, the WW Group will contact you for additional information and assistance.

Material Requests:

  • Agenda (final copy or draft)
  • Background/Outline of the program, purpose and other guest speakers
  • Brochure, website or other background material on your organization
  • Final copy (or draft) of press releases
  • Map/Directions to the facility
  • Convenient parking space and complimentary parking pass

Requester's Information

Name and Title (required)

Organization (required)

Street Address (required)

City, State, Zipcode (required)

Telephone (required)

Email (required)

Referred By (required)

Event Information

Date of the Event (required)

Time of the Event (required)

Location Address (required)

Type of Presentation (required)

What's the exact time Florine will speak? (required)

Topic (required)

Anticipated Audience (physicians, public, business women, etc.) (required)

List all participating speakers (required)

Additional Information (check all that apply) (required)
 Media coverage is expected Pictures will be taken during the event Florine Mark's biographical statement is needed prior to event Date Requested Submitted

Please type the verification code below. (required)

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Please be aware that Florine has a speaker's fee.

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