Speaker Request Form

Please complete the following form and submit it to receive additional information about having Jerry Hay make a presentation for your organization or school. Provide as much information as possible. Note that fields marked (*) are required.

Mailing address:
River Books & Programs
5916 St Marys Rd
Floyds Knobs, IN 47119
(Phone contact number will be provided if requested on this form)
Email: [email protected]

Requesting Organization
Contact Name
Contact Phone
Contact Email
Date of Event (if unknown, please indicate month or time of year)
Event details (include information regarding location, time, ticketed vs free, other speakers, etc.)
Audience (description of who will be in attendance)
Estimated attendance
Requested speaking topic
Requested speaking time/s
Would you like a Q&A to be part of the presentation?
Budgeted speaker's fee
Will book sales be permitted (if yes, this will often help offset speaker's fees)
Travel expenses paid
Any other information you would like to provide or request
Submit

Thank you for contacting us. We will get back to you as soon as possible

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