Speaker Request Form

Name *

First Name Last Name

What is the name of your business/ministry? *

Email *

example@example.com

Phone Number *

Please enter a valid phone number.

What is the date of your event? *

Date

Type of event: *

Event Location: *

Amount the Honorarium Pays: *

In what capacity would you like Selena to serve in? *

Keynote Speaker Workshop Facilitator Group Coaching One On One Coaching Seminar Facilitator Author Appearance Other

What is the expected amont of time you desire Selena to perform the chosen services? *

How many participants do you expect to be in attendance for your event? *

Is your event local or virtual? *

How do you plan to introduce Selena to your platform? *

Do you require Selena to give away products/services at your event? If so, which items? *

How do you desire to receive Selena's press kit? *

Email Regular Mail

Who is the intended audience for your event? *

PLEASE NOTE:

This request for Selena Gibbons to appear at your event is a request and does not lock in your date. You will receive a follow up email from our admin solidifying the honorariam and other details surrounding your event. This includes the official contract, vending table agreements, arrangements for hotel, lodging, meals, etc.

Please allot 3-5 business days for a response to your inquiry.