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Speaking Request Form

Questions? Call 704-968-2253

Mailing Address

Meeting Specifics

Is meeting date fixed or tentative?

Overnight Accommodations

Hotel Address

Logistics

Can you supply (check all that apply)

Expenses (Meetings less than 200 miles)

Can you provide a detailed map?
Yes
No
Will auto travel of 67 cents per mile be covered?
Yes
No

Expenses (Meetings more than 200 miles)

(Air travel arrangements will be made by Dr. Gigi unless agreed otherwise)

Will air travel be covered in advance?
Yes
No

Person Completing Form

Note:

Once a letter confirming all arrangements has been sent, the hiring organization or client will be responsible for a cancellation fee equal to 25% of the agreed-upon amount if they cancel the engagement. Additionally, the hiring organization or client will be responsible for reimbursing any non-refundable airfare, travel costs, or miscellaneous expenses incurred.

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