Speaker Request Form

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Company or Organization Name* This field is required.
4
Phone Number* This field is required.
Area Code
Phone Number
5
Proposed Event Date 1* This field is required.(If the date is not finalized, please put a tentative date)
Date
Month
Day
Year
6
(Alternate) Event Date* This field is required.What other date could your event take place)
Date
Year
Month
Day
7
Conference Name or Event* This field is required.
8
Expected Audience Size For Proposed Session
9
Event Type
10
What type of talk would you like Kaya to do?* This field is required.
Host/Facilitate
Breakout Session
Keynote
Trainer
Panelist
11
Is the event free for attendees?* This field is required.
YESNO
12
Who is the proposed audience and what kind of financial topics might be of interest to them?* This field is required.(age range, income range, life-stage, profession......)
Huge
Large
Normal
Small
Ok
Ok
13
Which signature presentation/topic are you most interested in? Scroll down the list for signature presentations. Custom topics can be created upon request.
Custom Presentation Tailored To Specific Company & Employee Benefits
Closing The Personal Wealth Gap (For Women)
Closing The Personal Wealth Gap (For Black Women)
Closing The Personal Wealth Gap (For People Of Color)
Personal Finance 101 For Early Career Lawyers
Personal Finance 101 For Early Career MBAs
Personal Finance 101 For Early Career Doctors
Planning For The Unexpected: An Intimate Workshop For Extended Families
Strategies For Black & Brown Financial Wellness
Managing Your Finances Amidst Volatility
14
What's Your Speaker/Trainer Budget?* This field is required.
15
Will your organization be interested in purchasing or subsidizing additional financial coaching services or trainings for its members/audience? We'll follow up with options that can be made available for your audience.
YESNO
16
Thank you for submission. Please expect a response within 3 business days.
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