Thank you for inviting Derek Anderson, Sr. to be a speaker or presenter at your event.

We appreciate your inquiry and would like to learn more about your event/ organization. Please fill out the following questionnaire and click the submit button. All requests should be made at least 60 days, in advance, of the proposed event. Once reviewed, you will be contacted by someone from the Derek Anderson Foundation.

POC Name
Mailing Address
Email Address
Website Address
Date Submitted
What is the nature of this event
(e.g., seminar, workshop, motivation speech)?
Please give a brief statement describing your
organizations/ events history?
What is your Organization's mission?
Please name individuals and/ or sponsoring
organizations associated with your event
(i.e. President, Board members, Director,
Companies, etc)?
What is the date of the event
(please include the specific day of the week and year)?
Confirmed Venue Location
(including City & State)
What is the desired message and intent?
Please describe past events you have done
and other presenters you have hosted.
Who will be promoting this event?
How will this event be promoted?
Are there specific topics that you would prefer
Mr. Anderson to speak about?
Are there any specific topics that you would prefer
Mr. Anderson to not speak about?
Will there be other speakers? If so, who?
What are the demographics of the target audience?
Approximately how many people do you anticipate?
Will there be admission for the event? If so, please describe.
How will you provide the financial arrangements for
Mr. Anderson (e.g., speaking honorarium, travel,
food, and accommodations)?
*Please provide us with any other additional information
about your project below.