Speaker Request Form
Paige Mathison | The Optimistic Speaker
Form Sections to Expect
General Contact Info & Event Details | Topic Details | Budget | Additional Comments & Questions
Contact Name
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Organization, Event &/or Podcast Name(s)
*
Please note if the organization is a Not For Profit
Location Details
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In-Person (City & Venue) | Online (Platform Being Used
Event Date & Time
*
Share confirmed, pending and approximate times/dates.
Amount of Speaking Time
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Examples: 20 Minutes, 1 Hour, Multiple Sessions, Full Day, Flexible or Unknown
What Form Of Guest Are You Seeking?
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Keynote Speaker
Guest Speaker
Panel Discussion
Emcee & Hosting
Retreat Speaking or Chat
Workshop or Seminar Facilitator
Podcast or YouTube Guest
Other
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What would you like me to discuss or speak on?
Healthcare Speaking
The Human In Us: Being a Trauma-Informed Healthcare Team
I've Got This: Building a Sense of Strength in a Chaotic Space
Medical Trauma: Reducing the Reality of Traumatized Patients & Professionals.
Other
Enhancing Joy
Laughter Enhancement: The Power of Expressing Joy
Pleasant Emotions: Understanding, Sparking & Connecting
Cultivating Joy: Enhancing Values & Releasing Shame
Trauma Prevention & Growth Potential
Other
Please Describe Further (if desired)
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Budget
I acknowledge the vulnerability in sharing what your planned budget is for services. This piece includes honorariums and invoiced payments. My consultations are FREE and approximately 30 minutes. Please know that regardless of what you share, I will connect with you via email!
Speaking Fee Budget
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$0 (Volunteer Speaking)
$0 (Variable Event Related Costs)
> $100
$100-$300
$300-$1000
$1000-$2000
$2000-$5000
$5000+
Other
Travel Expense Budget
*
No Separate Coverage (Included in Above Number)
Transportation Only (Flight, Gas, Cabs)
Accommodations Only
Transportation & Accommodations
Other
Further Budget Related Details (if desired)
Please Include any Variable Event Cost Details (Examples: ticket to event, meals, etc.)
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Additional Details:
What else would you like me to know? What drew you to reach out to Paige Mathison specifically? Please share any questions you have for me to answer when I respond to your reach out!
Share Below (if desired)
*
Please put N/A if no additional details come to mind!
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