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 Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Company Name
*
Event Details
Event Name
*
Date
*
-
Month
-
Day
Year
Date
Time
*
Hour Minutes
AM
PM
AM/PM Option
Location
*
Expected Number of Attendees
*
Please Select
Less than 50
50-100
100-500
500+
Speaking Engagement Specifics
Desired Topic(s) or Theme
*
Speaker Desired
*
Please Select
Abi Wasserman Ortscheid
Todd Ortscheid
Both
Duration of Speech/Presentation
*
Please Select
15-30 minutes
30-60 minutes
60-90 minutes
120 minutes+
Format of Engagement
*
Keynote
Panel
Workshop
Webinar
Other
Is there any equipment or technology provided?
*
Projector
Microphone
Laptop
None
Other
Additional Information
Have we spoken at this event or for your organization before?
*
Yes
No
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?
*
Yes
No
Partially
Additional notes or comments:
Submit
Should be Empty: