Inquiry Form: Speaking at a PPMD Luncheon

Speaker at a PPMD Luncheon Inquiry

If you are interested in being a speaker at one of our monthly PPMD Luncheons, please complete the form below. If selected you will be contacted by our events committee to finalize the details.
Speaker Name*

First NameLast Name
Business Name*
Contact Number*
E-mail*
example@example.com
Is There a Specific Month You are Looking to be our Speaker? **please note: by picking, there is no guarantee until contacted directly by the events committee to confirm***

ANYJanuary (unavailable)FebruaryMarchAprilMayJuneJuly (unavailable)AugustSeptemberOctoberNovemberDecember (unavailable)
Please tell us the topic you wish to speak about*
If selected as a speaker, would you like to be the food sponsor?*

No, please allow another business to sponsorYes, please send me the $250 invoice and provide food for meYes, I will arrange the food for 40 people myselfPlease contact me to discuss
This section is for you to provide specific information to ensure we have it in the event you are chosen as a speaker. We use this information on our flyers, email blasts, and introduction at speaking event.

1. BIO

2. Headshot/photo of yourself

3. Business logo

This section is not required but it does help get the information gathered quicker
Please submit your bio here if you are ready to do so
Please provide your headshot/photo of yourself

Cancelof
Please provide your business logo

Cancelof
Should be Empty:

Speaker at a PPMD Luncheon Inquiry