Speaking Event Details Form
Thanks for taking the time to complete this form, so we can learn more about your event! Karriem is very excited to work with you!
Event/Sponsor Organization *
Contact Name *
Contact Title/Position *
Address of Contact *
Contact Email *
Mobile Number *
Work Number *
Date of Event *
MM
/
DD
/
YYYY
Name & Address of Event Location *
Select Type of Venue *
If Other Please Explain *
Event Name *
Event Start Time *
Time
:
Event End Time *
Time
:
Event Theme *
If we could do anything to contribute to the success of your event, what would it be? *
Speaking Time Length *
Format of Talk *
Dress Code *
Names of other Speakers *
Projected Attendance *
Speaker Arrival Time *
Time Speaker Must Arrive To Event *
Time
:
Special Requests or Other Information
Event Speaker Budget
Submit
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