Speaking Request Form Name * First Name Last Name Organization Name * Email * Phone * (###) ### #### Event Name Type of Event * In-Person Virtual Event Location (In-Person ONLY) Address 1 Address 2 City State/Province Zip/Postal Code Country Event Date * MM DD YYYY Is Your Date Flexible? * Yes No Event Topic(s) * Expected Number of Attendees/Participants * Expected Length of Event * Demographic of Attendees/Participants * When considering the organization and attendees, what would make my involvement/talk a success? * What is Your Budget? * How Did You Hear About Me? * Thank you for reaching out.Please be advised that I’m unable to accommodate book/product reviews or pro bono engagements.Thank you for understanding.
