Speaker Request
Thank you for an inquiry to book Bahiyah Shabazz as a speaker at your event.
We are happy to learn more about the event, provide a quote, discuss availability, and anticipated participation as a speaker.
Please provide detailed responses which may include N/A or TBD for the following questions.
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Your Name and Title:
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Your answer
Email Address:
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Your answer
Organization's Name
*
Your answer
Organization's Website
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Your answer
Organization's Status
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Non Profit - 501(c)(3)
For Profit
Club or Association
Other:
Required
Event's Location:
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Your answer
Event's Theme:
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Your answer
What would you like attendees to get out of the event?
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Your answer
Date of Event:
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MM
/
DD
/
YYYY
Time of Event: (Please provide in CST)
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Time
:
AM
PM
Expected number of attendees:
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Your answer
Is the event free for attendees?
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No
Yes
If a paid event, what is the admission price?
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Your answer
Are there sponsors for the event?
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Yes
No
Maybe
Type of presentation requested:
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Webinar
Workshop
Panel Discussion
Panel Moderator
Keynote Speaker
Other:
Budget for requested speaker:
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Your answer
Are there special requests? Please check all that apply:
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Media interviews
Photo/Video Permission
Meet and Greet
Other:
Required
Can the speaker sell books &/or memberships at the event?
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Yes
No
Other:
Please provide additional comments for the speaker.
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Your answer
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