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Speaker Request Form
Thank you for considering Jefferson Noel as a speaker for your upcoming event. To help us best serve your needs, please fill out the speaker request form in its entirety. We look forward to the possibility of working together.
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Email
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Your email
Name of person making the request
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Your answer
Phone number
Your answer
Name of the organization
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Your answer
How many people are expected to be in attendance?
Your answer
Will the speech be video taped?
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Yes
No
I'm not sure yet
Will a photographer be present?
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Yes
No
I'm not sure yet
Is Jefferson allowed to bring is own videographer and photographer?
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Yes
No
I'm not sure yet
Topic of the presentation
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Your answer
Please provide details on expectations and takeaways from the presentation
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Your answer
Are you booking Jeff for a signature program? If yes, which one?
Crush the Competition: Strategies for Thriving as a Student Leader and Scholar
Building Bridges: Navigating Diverse Cultures, Philosophies, and Leadership Styles
Exposing the Lies: Truth vs Tall Tales About College
Finish Strong: The Value of a Degree in 2023 and Beyond
Making Lectures Relevant and Memorable: Strategies for Success
None of the above
Other:
Clear selection
Length of the presentation
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Your answer
Audience demographics (age, profession, industry, etc.)
Your answer
Date of the event
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Your answer
Time of the event
Your answer
Time Jefferson is expected to speak
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Your answer
Location of the event
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Your answer
Any special instructions for parking?
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Your answer
Would you like to purchase Jefferson Noel's books for all (or some) of the attendees?
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Yes
No
I'm not sure yet
Budget for speaker fee?
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Your answer
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