REQUEST A SPEAKER
Due to the large number of speaking requests we receive, we ask that all events make requests through this form to gather key details that are necessary to help us respond about Costales Brilliant Institute Center’s participation in upcoming events. This form is not a contract, but the first step in the process.
CONTACT INFORMATION
Organization Name
*
Contact Name
*
Full Name : First and Last Name
E-mail
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
EVENT DETAILS
Event Name
*
Event Date
*
-
Month
-
Day
Year
Date
Event Time
*
Start Time
Event Location
*
Anticipated Number of Attendees
*
Event Description
*
Audience
*
PRESENTATION DETAILS
Speaking Topic
*
Session Format
*
Speech
Workshop
Panel
Q&A
What will you like us to cover in the presentation?
Why do you want someone from Costales Brilliant Institute Center to speak?
Do you offer an honorarium?
*
Yes
No
Are you willing to reimburse expenses? (Travel/Lodging/Meals)
*
Yes
No
Are you willing to reimburse expenses? (Travel/Lodging/Meals) Please note that as a non-profit organization, Costales Brilliant Institute Center is limited to its ability to accept speaking requests that do not provide reimbursement for travel and lodging expenses.
*
Yes
No
Speaking Budget
Please Select One
1-5K
5-10K
10-20K
20-50K
50-75K
75-100K
100K
Deadline for Response
*
-
Month
-
Day
Year
Date
Enter the message as it's shown
*
Submit Request
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