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Speaking Questionnaire
Please complete the questionnaire below to book Michael to speak.
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* Indicates required question
Name
*
Your answer
Email Address
*
Your answer
Telephone Number
*
Your answer
Organization
*
Your answer
Title of event
*
Your answer
What type of speech are you requesting?
*
Keynote
Training
Panel
Other:
Purpose / intent / theme of event
*
Your answer
Date of event
*
MM
/
DD
/
YYYY
Location of event
*
Your answer
Audience size
*
Your answer
Speaker budget
*
Your answer
Age group of audience
*
Your answer
% women
*
Your answer
% men
*
Your answer
Keynote or presentation topic request
*
Your answer
Keynote or presentation length
*
Your answer
Do you have any special requests or any information you would like Michael to know?
*
Your answer
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