Speaker Request Form

Speaker Request Form
Name*

First NameLast 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?*

MonthDayYear
Date
Type of event:*
Event Location:*
Amount the Honorarium Pays:*
In what capacity would you like Selena to serve in?*

Keynote SpeakerWorkshop FacilitatorGroup CoachingOne On One CoachingSeminar FacilitatorAuthor AppearanceOther
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?*

EmailRegular 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.
Should be Empty: