request me for your speaking engagement or training

please fill in your details in this Speakers Request Form below and you will be contacted by a member of our team.
Please allow 2-3 business days for us to review your request. If you have an event that is less than 3 weeks away,
please give us a call to see if we can accommodate your request.

Fields marked with an asterisk (*) are required.

EVENT COORDINATOR INFORMATION

First name *

Last name *

PHONE NUMBER *

Email *

Date of the event *

START TIME

event type

event name *

Expected attendance *

booking budget for this event*

is this a for profit or non-profit event

presentation/speech details*

Presentation format*

audience details*

additional information*

IF OTHER PLEASE EXPLAIN*

How long is the event*

AUDIENCE (APPROXIMATE SIZE OF AUDIENCE. BRIEFLY DESCRIBE ITS MAKEUP AND IF MEMBERSHIP IS REQUIRED TO ATTEND.*

MEDIA: (WILL MEDIA BE INVITED? IF SO, WILL THE EVENT BE OPEN OR CLOSED PRESS? ALSO, DESCRIBE AND SUBMIT THE MEDIA LIST.)*

HONORABLE GUEST(S):( LIST NAMES + TITLES OF MEMBERS OF PROMINENCE, VIPS, PARTICIPATING IN OR ATTENDING THE EVENT).*

event organizer

name of organization submitting proposal*

Message

deadline for acceptance*

COST OF ATTENDANCE (PLEASE INCLUDE MEMBER AND NON-MEMBER PRICE, IF APPLICABLE).*

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request me for your speaking engagement or training