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Speaker Request Form
Thanks for your interest in inviting Chaka Y. Jackson to speak at your upcoming event!
This is not a formal agreement or contract to perform requested services. Please fill out the form below and someone from our team will return your email within 3 – 5 business days.
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Contact's First & Last Name
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Contact's Phone
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Contact's Email Address
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Organization Name
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Organization Website and Social Media Handles (if applicable)
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Event Title & Description (Please include information such as, is there an event theme? What are the event colors, if any? )
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Event Start and End Date
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Type of Event
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In-person
Virtual
Requesting Speaking Topic (if applicable)
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Event Address or Platform (Virtual Event). If the venue has not been confirmed, please provide the projected city & state or virtual platform.
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Requested Date(s) and Time(s)
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Requested Service
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Keynote/Main Speaker
Workshop Presenter
Panelist
Radio/TV Show Guest
Podcast
Other
What is the proposed length of Chaka Y Jackson's talk/training?
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Expected Number of Attendees
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Other Speaker(s) Invited to the Event
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Speaker Budget/Offer
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Additional Details
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