BROWN TABLE TALK SPEAKING REQUEST QUESTIONNAIRE

BROWN TABLE TALK SPEAKING REQUEST QUESTIONNAIRE

Thank you so much for considering Dee C. Marshall and Mita Mallick for your next event. Please complete this form to request them for an appearance or speaking engagement and we will respond within 3-5 business days.
Name*

First NameLast Name
Company/Organization*
Phone Number*

Area CodePhone Number
Email *
Website*
Department*

Talent Management/HRDiversity & InclusionLearning & DevelopmentBRG/ERG/Affinity GroupSupplier DiversityOther
Name of the Event/Theme *
Date of Event*
Who is the audience group?*

Mid Level LeadersExecutive LeadersWomen LeadersMid Level ManagersBRG/ERG/Affinity GroupExternal SuppliersExternal Clients/CustomersExternal ConsumersSuppliersOther
Number of Attendees Expected*
In what capacity would you like Dee and/or Mita to contribute?*

Fireside Chat/Panel with Dee & MitaKeynote (Dee or Mita)Workshop (Diverse & Engaged)
How long is talk time?*

15 minutes30-45 minutes60 minutesHalf-Day Session (email Dee@DiverseandEngaged.com)Full-Day Session or greater (email Dee@DiverseandEngaged.com)
Is this a live or virtual event?*
Will this event be recorded?*
What is your speaker budget that you are prepared to compensate Dee C. Marshall and Mita Mallick? (NOTE: Rates are virtual or live based on Dee's/Mita's value as a CEO, subject matter experts, seasoned professionals, media contributors, thought leaders and consultant to Fortune 10 Executives.)*
Upon acceptance of your request and a formal agreement we will provide a professional high-res head shot, written and read-it bio for marketing purposes. We do not approve nor authorize any likeness to Dee C. Marshall or Dee C. Marshall photos, videos or content from the public domain (i.e. internet, social media pages, web pages, etc.) for use in any of way. Do you agree to honor our request? *
www.browntabletalkpodcast.com| 973-755-6700 | Dee@DiverseandEngaged.com
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