Speaker Request Form

SPEAKING AND/OR WRITING REQUEST QUESTIONNAIRE

Thank you so much for considering Dr. Kyla L. Tennin, D.M. for your next event or project. Each of her speaking and writing categories, topics, and event types are purposeful, derive from deep personal, professional, board of directors, and business advisory experience. Please complete this form to request her for a speaking or writing engagement, appearance, or corporate training and we will respond within 3-5 business days.
Name

First NameLast Name
Job Title and Department Name
Company Name
Company Website
Your Corporate Email Address
example@example.com
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Corporate Phone Number

Area CodePhone Number
Date of Event

YearMonthDay
Date
Will the event require multiple days? Type yes or no.
Event Address (otherwise leave blank if event is virtual)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Conference/Event or Corporate Training and Theme
Department name the event will be held in?

Other
Who is the audience group?

Other
Will the conference/event, appearance, or corporate training be local, regional, national or interational and "in-person"? Or will it be "virtual"? (Or type N/A)
Is your organization planning to record the event? (Or type N/A)
Does the event need to be recorded? (Or type N/A)
Can Dr. Tennin recruit someone to record portions of the event, testimonials, or take a photo of her speaking at the event (e.g. 3-5 minute recording for her archives)? Type yes or no in the box. (Or type N/A)
Expected Number of Attendees
Event Type

Other
What type of talk would you like Dr. Tennin to contribue?

Other
Which Keynote Talk (a.k.a. Signature Talk) or Writing Service would you like Dr. Tennin to cover?

Other
Which Other Talk or Corporate Training(s) would you like Dr. Tennin to cover? (Or type N/A)

Other
How long is Dr. Tennin's talk time? (Or type N/A)

Other
What's your speaker/trainer or writer/editor budget you are prepared to compensate Dr. Tennin?
What professional trainers/speakers or writer/editor have you used in the past and what topics did they cover?
Are there any sensitive issues that I should be aware of or topics that should be avoided?
What are some of the current problems/challenges/breakthroughs experienced by your attendees, industry, organization, association or people?
What are 3 concepts or strong take-a-ways Dr. Tennin can deliver that will allow your attendees, industry, organization, association or people to maximize their performance?
Upon acceptance of your request and a formal agreement we will provide a professional high-res head shot, written, and read-it bio for marketing purposes. We do not approve nor authorize any likeness to Dr. Tennin or Dr. Tennin's photos, videos or content from the public domain (i.e. internet, social media pages, web pages, etc.) for use in any of way. Do you agree to honor our request? Type "yes" or "no" in the field and click submit.
Thank you for submission!

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SPEAKING AND/OR WRITING REQUEST QUESTIONNAIRE