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Dr. John Oda Speaking Request

1. Contact information: *

2. What is the location of the event? *

3. Date and Time of event? *

4. Planned # of attendees: *

5. Who else will be speaking: *

6. Price to attend this event (If there are packages available... What are the package prices?): *

7. Will anything be sold at this event? (If Yes, What will be sold? Price point?) *

8. Speaker Budget: *

9. What is your attendees primary focus in life? *

10. Is there a specific profession that most of your attendees would be grouped under? *

11. What is the biggest PROBLEM your attendees faces? *

12. What do your attendees want MOST in life? *

13. What do you feel is keeping them from achieving what they want most? *

14. What topic(s) would you like Dr.John Oda to focus on during the Speech/workshop? *

15. How did you become aware of Dr.John Oda? *

16. Please list 3 references and their contact (e-mail/Phone) *