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Name

First Name Last Name
E-mail
Phone Number

Area Code Phone Number
In 5 sentences or less tell me about your event.
What is the Event or Company website URL?
When is the event taking place?
Where is the event taking place?
What are you interested in having Chelsea do at your event?

Speaker Panelist Event Host Onsite-Influencer, Live Posting All of the above
What topic are you interested in having Chelsea speak on?
Is there compensation for this speaking engagement?
Are you interested in adding a #Millennialtalk Twitter Chat to this engagement?

Yes No Open to learning more What is a Twitter Chat?
How did you learn of Chelsea?
Have you worked with influencers before?

Yes No
Email
example@example.com
Phone Number

Area Code Phone Number
For those located out of the U.S, drop in your Skype name.
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Looking forward to speaking with you,

Chelsea
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