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Speaking/Events Booking Form
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* Indicates required question
Your Name
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
Organization/Company Name
*
Your answer
Your Role
*
Event Organizer
HR/Learning & Development
Conference Director
Company Executive
University Administrator
Accelerator/Incubator Manager
Other:
If Other, Please Indicate Below
*
Your answer
Event Type
*
Conference
Corporate Retreat
Team Offsite
Workshop
University/Academic Event
Industry Association Meeting
Virtual Event
Other:
If Other, Please Indicate Below
*
Your answer
Event Date
*
MM
/
DD
/
YYYY
Event Location
*
Your answer
Expected Audience Size
*
Under 50
50-100
100-250
250-500
500-1000
1000+
Preferred Session Format
*
Keynote (30-60 min)
Workshop (90-180 min)
Fireside Chat (30-45 min)
Half-day Intensive
Full-day Program
Multiple Sessions
Not Sure - Need Recommendation
Required
Audience Profile
*
Entrepreneurs/Founders
Corporate Executives
Sales Teams
Marketing Teams
Operations Managers
Early-career Professionals
Students
Mixed Audience
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