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Speaker, Presenter & Consultant Request
In order to evaluate our availability for your request, please complete the form below. Please allow at least 3-5 business days for a response to your request.
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* Indicates required question
Name of Organization/Affiliation
*
Your answer
Contact Name
*
Your answer
Email Address
Your answer
Type of Event (Panel, Workshop, Conference, etc)
Your answer
Event Request Date
*
MM
/
DD
/
YYYY
Event Request Time
Time
:
AM
PM
Event Description
Please address the following in your description: Who is the audience? How many people will be in attendance? Will there be other speakers? Please add any relevant information.
Event Description
*
Your answer
Does this request include travel, meals, and accommodation being fully covered?
Include information in regards to inclusion of flight, meals, hotel, transportation, etc.
Does this request include travel, meals, and accommodation being fully covered?
Your answer
Speaker, Presenter or Consultant Fee
Speaker, Presenter, or Consultant fee will be based on length and type of engagement and will be up to the discretion and mutual agreement between the speaker and the event organizer.
Speaker, Presenter, or Consultant Fee
Your answer
Any additional information needed to be disclosed about the event
Your answer
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