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Speaking Engagement Request Form
To assist us serve you effectively, we ask that you complete this form as part of the requirement to have our principal consultant (Mr Fowowe) speak/participate in any event.
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* Indicates required question
Title
*
Your answer
Full Name
*
Your answer
Institution / Organization
*
Your answer
Website
Your answer
Email Address
*
Your answer
Phone
*
Your answer
Event Name/Theme
*
Your answer
Event Location (The location should include Venue, City & State)
*
Your answer
Event Date
*
MM
/
DD
/
YYYY
Event Start Time
*
Time
:
AM
PM
Event End Time
*
Time
:
AM
PM
Facilitators Start Time
*
Time
:
AM
PM
Duration
*
Your answer
Type of Event
*
Conference
Workshop
Guest Speaker Event
Panel Session
Other:
Required
What is the group's objective in having Mr Fowowe speak or attend?
Your answer
Does the group have any special interests, topics or concerns that should be addressed?
Your answer
Anticipated number of attendees?
Your answer
Please describe the audience:
Your answer
Is there anything else that you would like for us to know about your event?
Your answer
What is your budget for the speaker (Engagement fee $1000)
*
Your answer
Incase the speaker is not available, would you want someone else?
Yes
No
Maybe
Clear selection
Would you like to talk to someone on the team? If Yes Call Amare on 08125120410
Your answer
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