Speaking Engagement Inquiry 
Thank you so much for your speaking engagement inquiry. Please complete the form below so we can provide you with a quote catered for your specific event. For questions, please email us at speaking@fearlessindependence.com. 
Sign in to Google to save your progress. Learn more
Email *
How did you hear about us? *
What is your name and affiliation? *
What is the name of the organization/company hosting the event? *
What is the name of the event/conference/course? *
What is the date and time of the event? If the date is not set please provide options
 *
What is the reach for the event? *
Please provide the location (city/state) hosting the event? *
What type of format are you seeking for a speaker (Check at least one)?
 *
Required
Who is the target audience? Include the industries and specialties represented  *
What is the estimated number of attendees/listeners?
 *
Please provide a brief description, purpose, and goal of the event/conference/course?
 *
Please list the topic(s) that would best target your audience and create the most impact.
 *
Who from the Fearless Independence team are you interested in having speak at this event? We offer joint and individual presentations depending on which provides your organization the most value. Please refer to the bios on our website to learn about the individual perspectives and expertise of each speaker.
 *
Required
What is the length of time allotted for the speaker’s presentation? *
.Would you like the speaker to prepare multimedia visuals (pictures, videos, text via PowerPoint) to accompany the speech? *
Would you like to include an Q&A session (excluding time allotted for the presentation)? *
How is the event marketed and promoted; ie. to the public or through intraorganizational channels only?
 *
Will the event have sponsors or partners?
 *
What is the allocated speaker budget for this event? *
Is the event virtual or in-person?
 *
If you selected in-person or hybrid above, please answer the following question. If you selected virtual, please skip ahead and submit the form.
Would you like the speaker to present in-person or virtually?
Clear selection
Do you have any additional information or comments you would like to share?
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Fearless Independence, LLC..

Does this form look suspicious? Report

Google Forms