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Speaker Request Form
To book Chike for a speaking engagement, submit this completed form and someone will follow up with a phone call.
Email address *
Purpose of Appearance *
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Requester/Authorized Party *
Name:
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Host / Sponsorships Institution / Title / Department:
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Complete Address: City, State, Zip Code:
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Contact information: Phone:
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Email:
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Requester/Authorized Party
Other Contact:
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Purpose of Appearance *
Program Title:
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Purpose of Appearance *
Date of Event / Start Time / End Time
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Location
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Type of Venue
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Promotional Interviews (Print / TV / Radio):
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Audience Type *
Target Audience:
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Audience Type *
Age Group:
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Audience Type *
Anticipated Audience Numbers:
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Budget *
Estimate Amount:
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Other Details
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