Speaker, Presenter & Consultant Request
In order to evaluate our availability for your request. please complete the form below. Please allow at least 5-7 business days for a response to your request.
**Please note if a quicker response is needed place a note in the additional information area.**
* Required
Name of Organization/Affiliation
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Contact Name
*
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Contact Phone Number
*
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Email
*
Your answer
Type of Event (Conference, Panel, Workshop, etc.)
*
Your answer
Event Request Date & Time
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MM
/
DD
/
YYYY
Time
:
AM
PM
Event Description
Please address the following in your description: Who is the audience? How many people will be in attendance? Will there be other speakers? Please add any relevant information.
*
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Does this request include travel, meals, and accommodation being fully covered?
Include information in regards to inclusion of flight, meals, hotel, transportation etc...
*
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*
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Speaker , Presenter or Consultant Fee
Speaker, Presenter or Consultant fee will be based on length and type of engagement and will be up to the discretion and mutual agreement between the speaker and the event organizer.
*
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Any additional information needed to disclose about the event
*
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