Request a Speaker

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Please fill out the application form below to request a speaker and invite our CEO to share her insights and expertise at your next event or corporate meeting.

First name*

Last name*

Phone*

Email*

Organization or affiliation*

Street Address (Organization/Affiliation/Location of Event)*

Date and time of event*

Month

Day

Year

Time

:HoursMinutes

Name of Event/Training/Presentation, etc.*

Are multiple presentations needed? (Ex. 3-day event from 9 am - 11 am)*

Yes

Length of speaking engagement/training/presentation? (Hours/days)*

Speaking/presentation topic*

Please provide details on the nature of your request.*

Audience size*

1-5

6-15

16-30

30+

Describe the audience. What do they do? What are their challenges? What do they want to learn/take away from this session?*

A/V equipment available?*

Yes

Internet access available?*

Yes

Will you allow us to photograph the event? If no, please explain why below*

Yes

Short answer

What is your budget for this speaker/presentation?*

What are the guidelines for travel budget and arrangements? Should I book the travel or will your company handle that?*

Please check yes, that you agree to providing a contract in order to finalize arrangements for a speaking event/training/presentation/engagement.

Yes, subscribe me to your newsletter.

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