Speaking Engagement Request
Please provide contact information for the primary event coordinator.
Full Name
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Organization
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Organization Website
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Email Address
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Phone
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Date of the Event
MM
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DD
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YYYY
Venue
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Expected Audience size
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Audience Demographics
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Please select the requested speaker for your event:
What is your budget for the speaker including travel and lodging fee? Minimum $1500
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Confirmed Speakers
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Invited Speakers
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Past Speakers
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Confirmation Deadline
MM
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DD
/
YYYY
Event Link
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What is the theme of your event and the expected speaking topic?
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Please provide any additional information about your organization, your event and/or reason for your request:
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