Speaking Event Request Form

Name

Email

Phone Number

Name of Organization/Group

Website (if applicable)

Name of Event or Conference

Theme or Focus of Gathering

Date of Event

Time of Event

Expected Number of Attendees

In-person, Virtual, or Hybrid?

If in-person, what is the event address?

Exact number of hours the speaker is expected to be in attendance, including early arrival or login, Q&A, and participation in any pre-event or post-event meetings and discussions.

Will this event be streamed live, recorded or shared on Social Media?

What is your budget for the speaker slot?

Will hotel and travel expenses be reimbursed?

Is this event for profit or nonprofit?

Which topic are you interested in?

Who else is speaking and what are their topics?

valentinesday

Hart-day!

Speaking Event Request Form