Request Khadija:  Questionnaire
Thank You for choosing Khadija Romney to be a speaker at your event.
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Contact Person (s)
Contact Person(s) Email
Contact Person (s) Phone Number
Location of Event (Provide Address if possible)
Social Media URLs (Facebook, IG, etc)
Website
Date
MM
/
DD
/
YYYY
Time
Time
:
Which Speaking Option are you expecting Khadija to execute? *
Speaking Topic *
If this engagement request extends beyond one day, please list all dates.
Theme/Title and Event Details
Type of Engagement
Projected Attendance
Closest Airport
Is there a registration fee for this event?
Clear selection
What is the amount($$$$) you have budgeted for Khadija Romney (excluding travel expenses)? *
Is the sale of products permissible?
Clear selection
Are you able to provide at least one (1) 8-foot table to display and sell products?
Clear selection
Will the event be video recorded?
Clear selection
Will the Event be Audio Recorded?
Clear selection
Will the Event be Live Streamed?
Clear selection
Submit
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