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Kimberly Jones Speaker Form
This is a request to have KiMii speak at your event. Please assume travel & lodging expenses with speaker budget.
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* Indicates required question
Email
*
Your email
Full Name:
*
Your answer
Organization:
*
Your answer
Website:
*
Your answer
Date of the Event:
*
MM
/
DD
/
YYYY
Name of the Event
*
Your answer
Location of Event
*
Your answer
Will KiMii be allowed to sell any of her merchandise?
*
Yes
No
Maybe
Time of Event
*
Time
:
AM
PM
Expected Number of Attendees?
*
Your answer
What type of talk?
*
Keynote
Panel
Workshop
Other:
Speaking Topic:
*
Your answer
Speaker Budget
*
Your answer
Additional Details?
Your answer
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