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Booking Request
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* Indicates required question
Name and Title of Contact Person
*
Your answer
Phone Number:
*
Your answer
Email
*
Your answer
Name of Organization
Your answer
Organization Status
*
For Profit
Non-Profit
Date of Event
*
MM
/
DD
/
YYYY
Name of Event
Your answer
Event Description
*
Your answer
Event Location
Your answer
Confirmed Speakers
*
Your answer
Expected Number of Attendees
Your answer
Is this event free to attendees?
*
Yes
No
If not, what's the admission price?
Your answer
Type of Presentation Requested
*
Podcast
Panel Discussion
Breakout Session
Workshop
Keynote
Other:
Duration in Minutes
*
Your answer
Budget for Requested Speaker/Presentation
*
Your answer
Will you also pay for travel?
*
Yes
No
Will you also pay for travel?
Yes
No
Clear selection
What do you want your attendees to get out of your event?
Your answer
Can products be sold at this event?
Yes
No
Clear selection
Can contact and info sheets be given to attendees?
Yes
No
Clear selection
Will any media outlets be present?
Yes
No
Maybe
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Additional comments, special requests or questions:
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