TC Headley Presenter/Trainer Request

1

Name* This field is required.

First Name

Last Name

2

Organization/Brand Name

3

Email* This field is required.

example@example.com

4

Phone Number* This field is required.

Please enter a valid phone number.

5

Website

6

Social Media

Facebook

Twitter

Instagram

Tik Tok

YouTube

7

About the Event

Event Name

Event Link

Event Date(s)

Event theme/topic

8

How Many Days Will TC be Needed for the Event?* This field is required.

One Day

Multiple Days

9

Will the Event be In-Person or Virtual?* This field is required.

In-Person

Virtual

10

What Type of Session Will TC Participate In?* This field is required.

2 Hour Workshop

60-Minute Seminar

30-Minute Training

15-Minute Presentation

Panel Discussion

Other

11

What is the Anticipated Number of Attendees?* This field is required.

12

What is the Presenter Rate/Honorarium for This Event?

13

What Would You Like Your Audience to Take Away?

14

How Did You Hear About Us?

15

Any Additional Details?