Welcome to the Speakers Inquiry Form

Welcome to the Speakers Inquiry Form

Thank you for your interest in booking Ashley M. Scott for your organization’s speaking engagement. Please fill out the form below and include as much details as you can. A Data Girl Ash representative will review and contact you with the following steps after your form is submitted.
Event Details
Name of Event *
What is the Theme/Topic of your Event? *
Event Date *

Month Day Year
Date
Proposed Event Time *

: Hour Minutes AM/PM Option
What type of speaking are you interested in? *

A Guest Appearance at your Event Award Presenter Be Interviewed by Ashley Host/Co-host your event Keynote - full day Interview Ashley - Radio, Television, Podcast, Summit, Other (one time interview or a series) Keynote - multiple days Mastermind - half day/evening Mastermind - multiple days Participate as part of an Expert Panel Master of Ceremonies - emcee your event Retreat Speaker Speaker at your Product Launch (endorsement)
Length of presentation time
Will this event be virtual? *

Yes No In person and virtual component Undecided
Address of Venue

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Expected Number of Audience *
Composition of the audience? (please include estimates on % women, %black/latino, etc)
What do you want your audience to take away and really get out of this event? This helps Ashley to customize her presentation for your event to meet your goals and objectives. *
What is the composition of the other speakers? (please include estimates on % women, %black/latino)
Besides the actual speaking day, are there other time commitments needed from Ashley? *
Is your event sponsored? If so, please provide details *
If you are recording this event, will you provide us a copy of the recording for our unrestricted use? *
How will you promote and market this event? Please email any marketing materials for approval before using please. *
What is your budget? (including travel & accommodations) *
Contact Details
Name of Organization *
Industry or Profession
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Website Address
Please provide a link to your event’s website (alternatively please attach a draft agenda / program)
Contact Person *

First Name Last Name
Phone Number

Area Code Phone Number
Email Address *
example@example.com
Is there anything else you wish to share with us about your event that you think we should know?
Should be Empty:

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