Thank you for considering me for your event. Please complete the form below and my team or I will follow up soon.

First Name

Last Name

Phone *

Email *

Your Event Name *

Your Event Type *

Event Dates *

Your Event Location *

Expected Audience Size *

Who is the primary audience for this event? *

What outcome do you want for attendees? *

Why do you feel I'm a fit for this room? (This helps me tailor the experience if we move forward.) *

What topics are you most interested in? (Feel free to list multiple.) *

Do you have a preferred session length? *

Is there a budget allocated for your event? *

Yes

Open to discussion

Will your event be recorded or repurposed? *

Yes

Unsure at this time

Is there anything else that you believe I should know about your event? *

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