Chanika Turner Speaker Request Form

Chanika Turner

Speaker Request Form
Contact Person*

First NameLast Name
Company/Organization*
Phone Number*
Please enter a valid phone number.
Phone Number*
Please enter a valid phone number.
Event/Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EVENT DETAILS
Theme/Topic*
Event Date*

MonthDayYear
Date
Event Time*

Hour Minutes

AM/PM Option
Desired Length of Presentation*
Presentation Type*
What your speaker budget?*
Are you requesting Chanika to deliver multiple presentations?*
If so, how many?
Open to the Public?*
Describe your audience (profession, size, primary language, etc.)*
What are their most common challenges?*
Topic of Interest:*

EntrepreneurshipThe Power of BeliefEntrepreneurship, Marriage, & SuccessOther
If your desired topic is not listed, please provide the topic you would like.
Is this event filmed or live streamed?*

YesNo
Will there be a vendor table available for Chanika?*

YesNo
Equipment & Travel
Does the venue have WiFi?*
Will audio visual equipment be available?*
Can products/services be sold at the event?*
What are your guidelines for travel budget and who will book travel?*
Is there any additional information the speaker should know?
If you are non-profit and you are requesting that this speaking engagement be an in-kind donation please provide the following information for the contact person who will provide proof of the in-kind donation.
Name

First NameLast Name
Title
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty:

Chanika Turner

EVENT DETAILS

Equipment & Travel