SPEAKING REQUEST QUESTIONNAIRE
Thank you for considering Dr. Chanda 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 & Event
*
How did you hear about Dr. Chanda?
Describe the event you wish Dr. Chanda to participate in & Which Topics would you like for her to cover?
*
How many attendees do you expect for your event?
Date of The Event
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Month
-
Day
Year
Date
Type of Event
Faith-Based
Collegiate (HBCU & PWI)
School-Based (K-12)
Non-Profit
Festival/ Cultural Event (e.g., Essence Festival, Revolt Summit)
Conference/ Summit
Corporate/ Workplace (ERGs/ Employee Wellness)
Government/ Public Sector
Media/ Panel Appearance
Brand Partnership / Sponsored Event
Dr. Chanda's Role
Please Select
Event MC/ Host
Keynote Speaker
General Speaker
Panelist
Speaking Time(s)
*
Set Speaker Budget (Please be advised that Dr. Chanda will be traveling from Washington, DC)
*
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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