C3 Speaker Request Form
Thank you so much for your interest in booking Christina for your next in-person or virtual event. Please take a few moments to fill out this speaker request form. The information you provide is super helpful in allowing the C3 team to better understand the specific items you are requesting. Thanks again for your support. We look forward to the partnership. God bless!

*Please note that air travel, ground transportation, and lodging is an additional expense if the in-person event is located outside of Chicago, IL.*

- The C3 Team
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Email *
First Name *
Last Name *
Phone Number (Start with area code) *
Company / Organization Name *
Company / Organization (Website) *
Company / Organization (Instagram) *
Company / Organization (Facebook URL)
Company / Organization (LinkedIn URL)
Is the org a 501(c)(3) / Non-Profit? *
Event Name *
Event Details (i.e. Theme, purpose, mission, audience / demographic, speaker expectations, event website) *
Exact Date(s) you'd like Christina to Speak (month / date / year) *Separate by commas if there are multiple dates* *
Specific Time(s) you'd like Christina to Speak (Include Time Zone) *Separate by commas if there are multiple times* *
Length of Speaking Engagement (How any minutes?) *
How would you like Christina to be involved? *
Required
What would you like Christina to address? (If other, please specify.) *
Required
How many people are you expecting to attend your event? *
Is this event virtual or in-person? *
If in person, please add the specific location (address, city, state, zip, country) or type "N/A" if virtual. *
What is your overall speaker budget? (USD) - This can be inclusive of air, ground, and lodging accommodations if the event is in person. *Please include a dollar amount or the application will be considered as incomplete* *
A copy of your responses will be emailed to the address you provided.
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