Speaker Booking Form

Booking Request for Dr. Ghia Kelly

Complete the form below to request Dr. Ghia Kelly for your event
Name of Event*
Type of event*
If other, please describe event below
Event Date and Time*
Is this event virtual or in-person?*

VirtualIn-person
If in-person, where will the event take place? (venue, city, state)
Tell me a little about the event and audience*
Name of Organization/Business Hosting the Event*
Contact Person*

First NameLast Name
Title/Role*
E-mail*
example@example.com
Phone Number*
Please enter a valid phone number.
Is this a paid or volunteer opportunity?*

PaidVolunteer
If Dr. Kelly is required to travel to this event, is your organization or company able to cover her travel expenses?

YesNo
Any additional information you would like to add about this request?
Please upload any relevant documents here (flyers, letters, etc.)

Cancelof
Thank you for requesting to book Dr. Ghia Kelly. Once the form is submitted, Dr. Kelly will review and follow-up with you within 3 business days.
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Booking Request for Dr. Ghia Kelly