Speaking and Event Pre-Interview
Your name
*
First Name
Last Name
Email
*
example@example.com
Phone number
*
-
Area Code
Phone Number
Organization
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Event leader
*
First Name
Last Name
Event leader email
*
example@example.com
Your role in the event
*
Event Information
Event title
*
Format of event
*
Virtual
In person
Hybrid
Other
Date of event
*
-
Month
-
Day
Year
Date
Number of years this event has been hosted
*
Preference of speaking topic focus
*
If you don't have this in mind, no problem. We can schedule a video or phone call to explore options to make this a great event for you.
Brief vision for the event
*
Estimated attendance
*
What's the target audience?
*
Speaker budget or anticipated honorarium (excluding travel expenses)
*
Additional requests
*
Meeting with event leadership team
Meeting with organization leadership team
Social event
Meet and greet participants
Book signing
Other
When should speaker arrive
*
-
Month
-
Day
Year
Date
Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Event Location
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of building
*
Closest airport
*
City
*
State
*
Airport distance
*
What else would be important for us to know?
*
Submit
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