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Speaker Request Form
Thank you for reaching out to us to request a speaker from our panel of inspiring women. Please provide as much detail as possible. We will reach out to you directly after you submit this request.
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Email
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Your email
Requester's Name (First, Last)
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Your answer
Title, Organization
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Your answer
Organization Website
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Your answer
Phone Number
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Your answer
City, Country
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Your answer
LinkedIn or other Social Media Handles
Your answer
Name(s) of Speaker(s) Requested
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Your answer
Organizer of the event (Company/Organization)
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Your answer
Please describe the event for which you are requesting the speaker(s). Include details such as its purpose, whether it is a ticketed event, any confirmed participants, and any confirmed or proposed sponsors.
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Your answer
Date of Event
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Your answer
Location of Event (Country, City)
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Your answer
Venue of Event
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Your answer
Expected size of audience
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Your answer
Audience Profile. Tell us who or what kind of people will be in the audience
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Your answer
Type of Engagement
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Talk
Interview
Fireside Chat
Podcast
Others (please describe below)
If you selected "other" please describe the nature of the engegement.
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Send me a copy of my responses.
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