Speaker/Trainer Request Form

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This form is used to understand what you are looking for. It allows us to aid you in meeting your need.

Email *

Name of requesting organization *

Point of contact name, email and phone number *

Event Name *

Event Date and Location *

Event Type (Dinner, Conference, Workshop etc.) *

Requested Topic *

PRESENTATION FORMAT (On location or on air?Keynote, Round Table, Panel, Virtual, Workshop etc.) *

EXPECTED DURATION *

WILL THERE BE A FOLLOW UP (Q&A or Reception)? *

AUDIENCE EXPECTED (Size/Attendance) *

What is your speaker budget? *

$250-$500

$500-$1000

$1000-$1500

$1500 or More

Other:

Any additional details (Attire, Travel Expenses, Dinning arrangements, Lodging/Transporation arrangements or other notes)? *

Send me a copy of my responses.

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