Language
English (UK)
Speakers Inquiry Form
Thank you in advance for taking the time to tell me about your event. I 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?
Be interviewed by Jaymes for the Catalytic Curiosity Podcast
Interview Jaymes - radio, television, podcast, other (one time interview or a series)
Keynote - full day
Keynote - multiple days
Lunch & Learn
Participate as part of an expert panel
Mastermind facilitation - multiple days
About Your Organization
Name of Organization
Contact Person
First Name
Last Name
Website Address
Industry or Profession
Is your company/organization a non-profit?
Yes
No
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
-
Area Code
Phone Number
Event Date
-
Month
-
Day
Year
Date
Event Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Title and Type of Event
What is the Theme/Topic of your 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)
Is your event sponsored? If so, please provide details
Desired Topics
Burnout Prevention
Stress Reduction & Redemption
Communication
Culture Development
Digital Wellness
Networking & Relationship-based Marketing
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.
How would you describe the demographic of your audience?
What is your budget? (including travel & accommodations)
What will be the cost of attendance for participants?
Is there anything else you wish to share with me about your event that you think I should know?
Submit
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