Jalaal "Dr. JAH" Hayes, Ph.D. Speaker Request Form
This form is used for speaking inquiries for Dr. Jalaal A. Hayes
Email address *
Contact Name *
Name of Company or Event *
Phone *
Address *
Name and/ or Theme of Event *
Date and Time of Event *
Will this event be virtual or in-person? *
Event Location (City, State, Country (if applicable) and Venue) *
Length of Presentation Time *
What is your budget for this presentation? *
A/V equipment available? *
Audience Size *
Describe the audience. What do they do? What are their challenges? What do they want to learn/take away from this session?
Will you film the event? *
If so, may the speaker request a copy? *
Will there be a vendor table available for book/product sales? *
Are you interested in purchasing books for the audience? *
Additional Information *
A copy of your responses will be emailed to the address you provided.
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