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Speaker Request Form
Thank you for your interest in having Tierra Dionna host and/or speak at your event. Please complete the form below and we will get back to you in 24-48 hours via email to provide you with the next steps.
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* Indicates required question
Name
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
Company/Organization Name
*
Your answer
Company/Organization Website
*
Your answer
Social Media Handles (Instagram, Facebook, YouTube, TikTok, etc.)
*
Your answer
Event Name & Theme
*
Your answer
Event Information Link (i.e. Eventbrite or promotional website)
*
Your answer
Event Type
*
Choose
Annual Event
Mixer/Networking Event
Charity Event
Conference or Retreat
Empowerment Event
Event Date
*
MM
/
DD
/
YYYY
Start Time - End Time
*
Your answer
Is your event virtual or in-person?
*
Virtual
In-person
Required
If your event is virtual, will it be live or pre-recorded?
Live
Pre-recorded
Clear selection
Event Location/Venue
*
Your answer
Event Address
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Your answer
How many attendees are you expecting at your event?
*
10-30
31-60
61+
Speaker Expectations (please select all that apply)
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Keynote Speaker
Host
Lead a Workshop
Moderate a Panel
Sit on Panel
Required
If you would like Tierra to be a Keynote Speaker, please provide the allotted time for her to speak below. (If this does not apply, please put N/A.)
*
Your answer
Speaker Topic (Please let us know if you have a specific topic request or would like for Tierra to provide her own topic.)
*
Your answer
Is there anything else you would like us to know about your event or speaker request? If so, please share below.
*
Your answer
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