WELCOA Speaking Inquiry

Please complete this form; it will help us to better understand how we can help you secure a speaker for your event. A WELCOA representative will contact you within 48 hours to discuss.



 

Proposed Date of Event:
Proposed Location of Event:
First Name:
Last Name:
Job Title:
Organization:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
Number of Employees: 1-10
11-50
51-500
501-5,000
5,000 +
Any Questions or Comments?
Mailing List: Yes! Please add me to your mailing list so that I can receive your workplace wellness updates!
 
Now please take a moment to tell us about the event you are planning so we may better respond.
Type of Event:
Potential Topic:
Length of Presentation:
Intent of Presentation:
(Please select all that apply)		 Inform
Persuade
Teach
Inspire
Entertain
Number expected to attend:
Industry of audience:
(Please select all that apply)		 Manufacturing
Corporate
Healthcare
Academic
Small Business
Other
Audience's educational backgrounds:
(please estimate a percentage each grouping will represent)		 % High School or Equivalent
% Undergrad
% College Degree
% Gradutate Degree
Audience's background and knowledge in topic:
Issues and concerns that most affect the audience: Increasing Productivity
Demonstrating Return on Investment
Reducing health care costs
Transforming Culture
Building programs that last
Creating a shared vision
Other