Request Speaker - PMAssist

Speaker Request Form

If you'd like to have Todd or Abi Ortscheid speak at your chapter, conference, or on your podcast - fill out the form below.
Contact Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Company Name*
Event Details
Event Name*
Date*

MonthDayYear
Date
Time*

Hour Minutes

AM/PM Option
Location*
Expected Number of Attendees*
Speaking Engagement Specifics
Desired Topic(s) or Theme*
Speaker Desired*
Duration of Speech/Presentation*
Format of Engagement*

KeynotePanelWorkshopWebinarOther
Is there any equipment or technology provided?*

ProjectorMicrophoneLaptopNoneOther
Additional Information
Have we spoken at this event or for your organization before?*

YesNo
What do you hope our speaking engagement will achieve for your event/audience?*
Any specific points or topics you'd like covered?*
Will there be other speakers? If so, who?
Compensation & Logistics
Speaking Fee Budget:*
Will travel and accommodation expenses be covered?*

YesNoPartially
Additional notes or comments:
Should be Empty:

Speaker Request Form