Request Speaker Form

Kiwana Thomas, Speaking Form

Kiwana can customize a topic to fit your audience's needs and interest
Your Full Name

First Name Last Name
First Name *
Last Name *
Phone Number *

Area Code Phone Number
Email Address *
example@example.com
Date of Event *

Month Day Year
Date
What type of event are you hosting? *
Event Location Type *
Event Location / Venue *
What is the event website/social media link? *
Time of Event *
Please put the entire event time frame
What is the focus / title of your event? *
Event topic you would like Kiwana to discuss: *
What day of the event will Kiwana be presenting / selling?
Have you done this event before? *
Who is the headliner or host organization for the event? *
Additional Speaker(s)?
Estimated Guest or Attendee Count?
If Virtual list
Are the speakers pitching or selling products/services? What price range?
When will we get paid? -- or do we process our own orders?
Do you have demographics on your audience? (age, income, business types, etc..)
What expenses will you be providing?
What equipment is provided?
What equipment do you expect Kiwana to provide?
What is the estimated Audience reach for promotion?
Will Kiwana have additional obligations in order to participate?
Financial Need Type
What areas of financial concern do you have, or tell us a little about your financial story? *
Should be Empty:

Kiwana Thomas, Speaking Form