Speak for Profit Application

Speak for Profit Application
Thank you for your interest in becoming a candidate for our Speak for Profit program. We are excited about you utlizing your gift of speeach to be impactful to our communities.
What type of speaking are you interested in?

KeynoteMastermindRetreat SpeakerParticipate as part of an Expert PanelMaster of Ceremonies - emcee your eventsHost/Co-host your eventAward PresenterSpeaker at Product Launches (endorsement)Interviewer- Radio, Television, Podcast, Summit, Other (one time interview or a series)Be Interviewed by Media OutletsA Guest Appearance at your Event
Tell us about you below:
Manager Contact

First NameLast Name
Website Address
Industry or Profession
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Name

First NameLast Name
Phone Number

Area CodePhone Number
Do you have any upcoming events that you need to be prepared for?
If yes, Event's Title and Type of Event
Address of Venue

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Estimated number of attendees?
What is your speaking style?

InspirationalMotivationalEmpowermentMindfulness Mindset and Mind Shift
Do you speak on Wellness Based Platforms if so which ones

Health and HealingHolistic Nutrition basedHolistic Diabetes NutritionHolistic Approaches - Integrative
Do you like to speak on Wealth & Financial Platforms

How to Create Wealth & Financial Freedom (Real Estate or Business)
What do you want your audience to take away and really get out of this event? This helps me to customize my presentation for your event to meet your goals and objectives.
What is the average revenue of your audience members?

$50,000 - $75,000 per year$76,000 - $100,000 per year$101,000 - $150,000 per year$151,000 - $250,000 per year$251,000 - $500,000 per yearOver $500,000 per year
What is your budget to invest in your platform? (including travel & accommodations)
How can Dr. J assist you in your speaking platform?
Is there anything else you wish to share with us about your event that you think we should know?
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