Speaker Request Form
After you fill out this order request, we will contact you to go over details and availability within 5 business days. If you have any questions prior to our contact or about the form please email Kellee@wisdom4thejourney.com or call 708.405.9648.
Email address *
Are you a new or existing customer?
What is the name of your organization? *
Your answer
Organization Address:
Your answer
Your name *
Your answer
Phone number *
Your answer
E-mail
Your answer
Preferred contact method *
Required
Organization's website or brief description of services provided:
Your answer
Event Title & purpose:
Your answer
Event Location
Your answer
Event Date:
MM
/
DD
/
YYYY
Event Start and End time
Time
:
Audience Demographics
Your answer
Expected Audience size:
Your answer
How are you marketing this event?
Your answer
Are they paying to attend the event?
Budget for the event:
Your answer
Topic of Presentation
Your answer
Type of presentation
Length of presentation
Questions and comments?
Your answer
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