Hosting & Emceeing Request Form

Hosting & Emceeing Request Form
Thank you for considering Rochelle Gapere as your Event Host or Emcee!

Please complete this request form so we can learn more about your event and check Rochelle's availability.

We will review your request and get back to you via email within the next 2-3 business days.

Let's get started!
Tell Us About Yourself
Your Name*

First NameLast Name
Your Company/Organization*
Your Email Address*
example@example.com
Your Phone Number*
Please enter a valid phone number.
Tell Us About Your Event
Event Name*
Event Location*
Event Date*
Event Time*
Event Description*
Tell Us About Your Speaking Request
Budget for Speaker*
Expected Audience Size*
Audience Demographics*

Company EmployeesGeneral PublicStudentsOther
What is the "Other" Audience Demographic?
Any special notes, requests, or equipment/AV requirements?
Privacy Policy*
Should be Empty: