DLJ Speaker Request Form
Thank you for your expressed interest in having me speak at your event. Please complete this form to provide me details of your event and how you envision my talk contributing to it's success. I will be in touch within 72 hours.
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Name *
Email *
Contact Number
Organization Name
Event Name & Topic *
Event Date *
MM
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DD
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YYYY
Event time *
Time
:
Type of Event *
Event Location (In-Person Only)
Expected Talk (What would you like to hear me speak about?) *
Length of requested talk? *
Expected number of attendees? *
Tell me a little bit more about your audience? (i.e. demographics, values, goals, challenges) *
What would make this talk a success for both your organization and the attendees? *
What is your budget for this event? *
Will your organization cover travel and lodging expenses? (In-Person Only)
Clear selection
Will the event be professionally recorded? *
Will the event be professionally photographed? *
How did you first come to find me? (Website, Instagram, Podcast, Friend/Family, etc.) *
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