If you would like to schedule Roland S. Martin or Jacquie Hood Martin as a speaker at your next conference or event please fill out the form below.

1. Speaker Requested(required)
2. Primary Contact's Name(required)
3. Primary Contact's Email Address(valid email required)
4. Primary Contact's Phone Number(required)
5. Primary Contact's Mobile Phone
6. Name of Organization(required)
7. Organization Website(required)
8. Organization Type College/University Corporation Government Association Non-Profit Speaker Series (required)
9. Organization Industry Health Care Transportation Banking/Financial Services Manufacturing Education Media/Broadcasting Legal/Law Enforcement Technology Communications Industrial Other
10. If Other
11. Additional Organization Details
12. Role in the Event Donation Award Recipient Panelist Moderator Honoree Keynote Speaker MC Guest
13. Prospective Date of Event - First Choice Date(required)
14. Second Choice Date(required)
15. Keynote Topic:(required)
16. Event Start Time(required)
17. Start Time of Speaker(required)
18. End Time of Speaker(required)
19. Event Name(required)
20. Description of Event (name of the event, length of speech, attire for event, format, topic, luncheon, dinner, reception or theater style seating) DO NOT INSERT PRESS RELEASE
21. Event Description: (required)
22. Panel Topic(required)
23. Please Provide the Specific Names and Affiliation of All Panelist Involved in this Event (include all invited and confirmation status)
24. Panelists: (required)
25. Venue Name(required)
26. Venue Address(required)
27. Venue City(required)
28. Venue State(required)
29. Venue Zip Code(required)
30. Closest Airport to the Event
31. Please describe the prospective audience that will attend this event (i.e. size, ceo, employees, etc)*
32. Audience description(required)
33. What media outlets will be present at this event? (radio, television, newspaper)
34. Media outlet details
35. How is the event being promoted?
36. Organization Will Cover Expenses
37. Yes No
38. Expenses Covered By Organization
39. Air Travel Car Service Hotel
40. Speaker will have products (book, tapes, etc.) available for your event. Would you be willing to provide 2-3 people to help sell Speaker’s products?
41. Will Administrative Support be made Available to the Speaker?
42. Yes No
43. Honorarium
44. Yes No
45. Honorarium Amount 0 - $1,000 $1,000 - $5,000 $5,000 - $10,000 $10,000 - $50,000
46. Deadline for Response(required)

 

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If the event is confirmed, we require a 50% deposit immediately upon acceptance, to secure the date on our calendar. The remaining 50% is due 10 business days prior to the date of the event.