Speakers Inquiry Form
Thank you in advance for taking the time to tell me about your event. Our Public Relations Team will get back to you shortly with the next step. Please complete the form below by choosing appropriate boxes of interest to you and your organization.
What type of speaking are you interested in?
Keynote - full day
Keynote - multiple days
Mastermind - half day/evening
Mastermind - multiple days
Retreat Speaker
Participate as part of an Expert Panel
Master of Ceremonies - emcee your event
Host/Co-host your event
Award Presenter
Speaker at your Product Launch (endorsement)
Interview - Radio, Television, Podcast, Summit, Other (one time interview or a series)
A Guest Appearance at your Event
About Your Organization
Name of Organization
Contact Person
First Name
Last Name
Website Address
Industry or Profession
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
example@example.com
Name
First Name
Last Name
Phone Number
Event Date
-
Month
-
Day
Year
Date
Event Time
Hour Minutes
AM
PM
AM/PM Option
What is the Theme/Topic of your Event?
Event's Title and Type of Event
Address of Venue
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Estimated number of attendees?
Please provide a link to your event’s website (alternatively please attach a draft agenda / programme)
Is your event sponsored? If so, please provide details
Speaking Request Objective
Inspirational
Motivational
Empowerment
Mindfulness Mindset and Mind Shift
Educational
What do you want your audience to take away and really get out of this event? This helps me to customize my presentation for your event to meet your goals and objectives.
What is your budget? (including travel & accommodations)
Is there anything else you wish to share with us about your event that you think we should know?
Submit
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