Dr. Victor Santiago Pineda - Speaker Request Form
Thank you for considering Dr. Victor Pineda as an seasoned inspirational speaker or subject matter expert for your event. Please read the following before filling out this form: 
  1. You can learn more about the topics and impact of Dr. Victor Santiago Pineda here
  2. Please review the presentation and prepare any questions you may have. 
  3. To further understand your needs, please fill in the following fields below and a member of our team will be in touch. 
For more information please email jothie@pinedafoundation.org. 
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Contact Name *
Contact Email Address *
Engagement Type *
Select all that may apply
Event Name *
Event Location *
Event Theme/Title *
Audience Size *
What impact you seek to create from the engagement. *
Organization Name *
List the name of the sponsoring organization or client.
Event Location (Physical Address or Virtual Platform) *
Event Start & End Dates *
Preferred Speaking Date (if available)
Preferred Speaking Time (if available)
Please include the timezone
Do You Have a Speaker Budget Allocation for this Event? If yes, please state the value. *
Dr. Pineda is a highly sought after speaker and cannot accommodate unpaid speaking fees. 
Agenda/Program URL or flyer
Do you intend to broadcast or record the speech? *
Please note that Dr. Pineda requires recorded speeches to be captioned and made accessible for all.
Logistics Coordinator Name & Email *
This could be the event curator, producer, or communications lead that manages speaker contracts.
Procurement Coordinator Name & Email *
This is the person responsible for executing contracts or billing.
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