Speaking Guest Request Form

1
Name* This field is required.
First Name
Last Name
2
Email Address* This field is required.
example@example.com
3
Phone Number* This field is required.
Please enter a valid phone number.
4
Name of Program/Event* This field is required.
5
Website of organisation booking* This field is required.
6
Is this a virtual or in person event?* This field is required.
VirtualIn Person
7
If in person, where will this event be located?* This field is required.
8
Date and time of event* This field is required.
9
What is your speaker budget for this event?* This field is required.Please note Erika receives many speaking requests and this information is required for our team to respond accordingly.
10
Estimated Audience Range (regional, national, international)* This field is required.
11
Proposed Topic* This field is required.We're happy to brainstorm ideas or you can refer to Erika's speaking kit
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12
Proposed Length/Format* This field is required.
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13
Any of your Social Media Links* This field is required.
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14
Any other information is welcomed* This field is required.
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Should be Empty: