Contact

Speaker Requests

First name

Last name

Event Title

What is the name of the event associated with this speaking engagement?

Link to Event Website

Please provide a link to the event website.

Street address

What is the event address?

Date of Event

What is the date of the event?

Date Confirmation Needed By

Indicate on which date you need a final commitment.

Speaker Report Time

Indicate what time the speaker should arrive at the location.

Speaker Start Time

Indicate what time the speaker will start his/her talk.

Talk Duration

Indicate how many minutes the invitee should speak.

Topic

Please describe in detail, the subject matter the speaker should prepare remarks.

Type of Engagement

Select the type(s) of speaking engagement you are requesting.

Panel SessionKeynote SessionBreakout SessionModerator of TalkOther Type of SessionInstructional Session

Speaker Request - Required Speaker Credentials

List all of the credentials or areas of expertise the speaker should possess.

Specific Speakers

Do you have specific people in mind for this speaker engagement? If so, please provide their name and organizaiton.

Compensation Amount

Is this speaking engagement compensated?

Other Value Adds

Indicate other value adds that you are including to incentivize speaker participation.

Speaker Request - Other Information

What else should we know?

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