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Speaker Request Form
Please complete the form and allow up to 72 hours to receive a response. Please submit your request at least 2 weeks prior to the event.
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* Indicates required question
Email
*
Your email
Organization Name
*
Your answer
Contact Name
*
Your answer
Email Address
*
Your answer
Contact Phone Number
*
Your answer
Event Name
*
Your answer
Summary of Event
*
Your answer
Date of Event
*
MM
/
DD
/
YYYY
Time
*
Time
:
AM
PM
Address of Event (if applicable)
Your answer
Estimated Size of Audience
*
Your answer
Type of Event
*
Presenter
Keynote
Panelist
Break out session
Other:
What is your speaker budget?
*
Your answer
Are attendees paying to attend this event?
*
Yes
No
How are you requesting Nandi to speak?
*
Your answer
Do you have event sponsorship?
*
Yes
No
Comments
Your answer
A copy of your responses will be emailed to the address you provided.
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