Speaker Requests
Thank you for your interest in booking Dr. Jackie the PA as a speaker at your next event. It is very important this form is completed in its entirety. The information provided will help prepare properly for your event and determine your rate. Subsequent correspondence will be via email or telephone. Please email jackie@jackiethepa.com for further requests
Email *
Event Name, Date, and Time
Contact Person's Name & Telephone number *
Email address *
Number of Attendees
Describe the Audience *
What topic would you like Jackie to speak about? *
Type of Speaking Request *
What is your speaker's budget? *
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