2023/24 Speaking Inquiry Request Form
Thank you for considering Chiereme Fortune for your next important event. Please provide the necessary event details below and a member of her team will get back with you within 72 hours. 
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First & Last Name *
Email *
Best Phone Number *
Title or Position *
Organization, Business or Initiative You Represent *
Event Host Website *
Event Date and Time *
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DD
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Event Title *
Event Location *
Length of Chiereme's Speaking/Performance Time *
Required
Event Description 
- What is the event theme?
- What is the event purpose?
- What is the audience makeup?
- Will there be additional speakers at the event?
- Is this a milestone year or occasion?
- What do you see Chiereme's role being in the event?
- What feelings, actions and thoughts do you want the event attendees to walk away with?
 *
Desired Participation for Chiereme *
Any other important details Chiereme needs to know or be aware of? *
How did you find Chiereme? *
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