Speaking & Performance Request Form

Thanks for your interest in scheduling Tania de Jong AM to engage with your event!

Please note that we receive a large number of event invitations for Tania de Jong AM and that her schedule is often booked out well into the future.

By completing this form accurately and thoroughly, you will help our team better evaluate and process your request.

While we work to process requests rapidly, please expect a 48 hour wait time to receive a response to your request.

We appreciate your support and patience with our process. Thank you again for your interest in bringing Tania to your event!

1. Contact Name*
2. Your Organisation or Company Name*
3. Contact Phone Number*
4. Contact Email Address*
5. Contact Website (optional)
6. Event Name*
7. Event Sponsors*
If any companies or organisations other than your own are major participants or sponsors of the event, please list them here (or N/A)
8. Date/s Requested for Appearance*
If your event will occur over more than one day, please note this in the next field.
9. Multi-Day Request / Alternate Dates
If your event will occur over more than one day, please describe here. Also, if there are alternate dates for Tania’s appearance at your event, describe here.
10. Venue for Event*
Where will the event happen? Please be specific.
11. Address for Event Venue*
12. Time of Day and Length of Appearance*
What time of the day would Tania present or engage? How long would her appearance last?
13. Size of Screen*
Tania's presentation will require a screen. Please describe the size of the screen(s) to be used for presentation.
14. Indoor or Outdoor?*
Would Tania's presentation take place indoors or outdoors?
15. Suggested topics / content for appearance*
16. Audience Profile*
17. Estimated Attendance*
18. Is the event open to the public, or only a certain group? Is there a cost to attend the event?*
19. Honorarium, travel and accommodation support offered*
20. Complimentary Tickets*
How many complimentary tickets could be made available for Tania’s supporters at your event?
21. Do you have experience producing events?*
22. Who else will be presenting at this event? Can you share a draft schedule? Please tell us who else has presented for you in the past with great success?*
23. Deadline to Accept / Decline Request*
We will be as responsive as possible, but due to the high volume of requests, please expect a 1-2 week timeline to receive a response.
- I understand
24. Additional Information
Anything else we should understand in evaluating your request?
25. Upload additional info
If you have any documents with supporting information, feel free to upload them here for our review. Only Word or PDF files. Maximum total upload 25 MB.
Drop files here or

Accepted file types: doc, docx, pdf, Max. file size: 25 MB, Max. files: 5.
Name
This field is for validation purposes and should be left unchanged.

Speaking & Performance Request Form

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