JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Michael Wear speaking request form
We are so delighted you'd like to invite Michael to speak. Please answer the following questions, and we will get back to you as soon as possible to discuss the opportunity.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Date?
*
MM
/
DD
/
YYYY
Time?
*
Time
:
AM
PM
Location?
*
Your answer
What is the desired topic?
*
Your answer
What is the format of the event?
*
Lecture
Panel
Interview
Digital platform (Zoom, Teams, YouTube, etc.)
Other:
Will there be an audio or video recording?
*
Yes
No
Other:
Who is the audience and how many do you expect?
*
Your answer
Honorarium offered? If yes, what is the amount?
*
Your answer
Are travel expenses covered?
*
Yes
No
Not applicable
Other:
Who should we contact to make travel arrangements?
Your answer
Is there anything else Michael should know about for this event?
*
Your answer
Please provide your contact details (name, title, email, mobile)
*
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report