Kemberley.com - Speaking Request Form
Interested in bringing Kem to speak at one of your next events? Please complete the short form below.
Your name *
Your answer
Your email address *
Your answer
Phone number *
Your answer
Organization's Name/Meeting *
Your answer
Date of event *
MM
/
DD
/
YYYY
Time of event *
Time
:
Time of event - ending time *
Time
:
Required time for presentation *
Your answer
What speaking topics are you interested in?
How many people are you expecting?
Your answer
Provide a brief description of the setup for the event (i.e. PowerPoint, Classroom style, etc.)
Your answer
Speaking payment options *
Speaking format style *
Please provide a link to your event or your organization's website. *
Your answer
Please provide additional information that may be helpful.
Your answer
Submit
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