Invite me to speak at your event
Hi there! My name is Robbie Samuels and I'm looking forward to discussing how I can support your participants by sharing valuable content in a highly engaging presentation.

Before we meet, it would be helpful if you filled out this form with as much information as is readily available.
Sign in to Google to save your progress. Learn more
Email *
Your Name *
Job Title *
Organization *
Your Email Address *
Your Phone Number *
Event DATE(s) and TIME(s) - please include timezone *
Name of Event *
I list several topics on my website and I'm open to considering new ones. What topic would you like me to focus on? *
Required
Purpose of Session - what transformation or outcome are you hoping to achieve through this talk? *
Number of Participants Expected *
I am also available as an emcee, event host, or facilitator - as well as producing virtual events and training virtual speakers. Are you interested in any of those services?
Is this in-person or virtual? If in-person, what location? If virtual, what platform (e.g., Zoom meeting, Zoom webinar)? *
Who referred you? I'd like to thank them.
Anything else you'd like to add?
Next steps...
Robbie Samuels will review your submission and email you to schedule a time to discuss your event needs. If you'd like to schedule something more quickly you are welcome to use the booking link on the confirmation page (you'll see this after you hit submit).

Questions? Robbie@RobbieSamuels.com
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms