SPEAKING REQUEST QUESTIONNAIRE
Thank you for considering Dr. Inga to speak at your event! Let's start the conversation.
Contact name
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Phone Number
*
-
Area Code
Phone Number
Name of Your Organization
*
How did you hear about Dr. Inga?
*
Name of your event
*
Time of your event
*
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2
3
4
5
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7
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9
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:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Virtual or Live Event
Virtual
Live
Venue Location, If Live:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Event Website
Describe the event you wish Dr. Inga to participate in
*
How many attendees do you expect for your event?
*
How many times do you wish Dr. Inga to speak at your event?
*
Event Type
Broadcast Interview (TV or Radio)
Corporate/Business Speaker/Empowerment Speaker
Ministerial/Inspiration Speaker
Set Duration (In Minutes)
Additional Speakers, if applicable
Speaking Date(s)
*
Speaking Time(s)
*
Closest Airport/Station
*
Thank you for filling out this speaking engagement questionairre. We will review your information and get in contact with you soon!
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