AI Speaking Engagement Request Form

Speaking Engagement Request Form
Contact Information
Full Name*

First NameLast Name
Organization/Company Name:
Position/Title:
Email
example@example.com
Phone Number
Please enter a valid phone number.
Event Information
Event Name:
Event Date(s):*

MonthDayYear
Date
VirtualIn-personBoth
Event Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event Start Time:

Hour Minutes

AM/PM Option
Topic(s) of Interest:*
What Industry are you in?*
Audience Description(Include audience size, age range, professional background, and any specific interests):
Speaking Format
KeynotePanel DiscussionWorkshopQ&A SessionFireside ChatOther
Duration of the Engagement
15–30 minutes30–60 minutes1–2 hoursHalf-day sessionFull-day session3-day sessionOther
Objectives and Goals
What are the main objectives or goals of the event?
Special Requirements or Requests
Is there any specific message, theme, or call-to-action you would like the speaker to emphasize?
Technical requirements for presentation (e.g., projector, microphone, virtual platform):
Any additional accommodations or requests?
Value-Added Options
YesNo
YesNo
Yes, pre-event promotionYes, live event coverageYes, post-event summaryNo
YesNo
YesNo
Live Q&A or Polling Tools: Allow attendees to ask questions in real time or participate in live polls.Interactive Hands-On Activity: For workshop formats, we can include a hands-on activity related to AI.
YesNo
Budget and Fees
Proposed Budget for Speaker Fees:*
Additional Expenses Covered: (Specify if travel, lodging, or other expenses are included)
Upload any additional files here:

Cancelof
Interest in AI Solutions and AIoT Services Post-Engagement

To provide additional value after the speaking engagement, we offer tailored AI solutions and AIoT services that can help automate processes, streamline operations, and enhance technology infrastructure. Please indicate any areas where you would like to explore further:
Please briefly describe any specific goals or areas of improvement where AI or AIoT could benefit your organization (e.g., automation, customer experience, data analysis:
Yes, we’d like a follow-up demoYes, we’d like a workshop for our teamNo, not at this time
Agreement: By submitting this form, you agree to discuss and negotiate the terms, fees, and other specifics if the speaker is available and interested in the engagement.
Signature*
Should be Empty:

Speaking Engagement Request Form

Contact Information

Event Information

Speaking Format

Duration of the Engagement

Objectives and Goals

Special Requirements or Requests

Value-Added Options

Budget and Fees

Interest in AI Solutions and AIoT Services Post-Engagement