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
Event Location(Specify if virtual or in-person; include city and venue for in-person events):

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
Format

KeynotePanel DiscussionWorkshopQ&A SessionFireside ChatOther
Duration of the Engagement
Duration

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
Would you like a custom e-book or Guide on AI for your industry (co-branded with your organization’s logo?):

YesNo
Would you like Personalized Presentation Slides with Event Branding(Our presentation can include your organization’s logo, event theme colors, and any specific branding elements.):

YesNo
Would you like a custom Social Media Blast and Promotion(We can promote the event through our social media channels, reaching an audience interested in AI and technology):

Yes, pre-event promotionYes, live event coverageYes, post-event summaryNo
Would you like Exclusive Access to Educational Resources(Would you like us to offer attendees access to a library of resources, such as articles, video tutorials, and research papers on AI for your industry?):

YesNo
Would you like a Customized AI Toolkit for Participants(We can provide a toolkit with practical resources on AI applications tailored to your industry or audience needs):

YesNo
Audience Interaction Features:

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.
Would you like a Post-Event Follow-Up Session(follow-up session to address further questions):

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:
Follow-Up Demo or Workshop on AI Solutions: Would you be interested in a follow-up demonstration, consultation, or workshop on how AI and AIoT solutions can be applied to your industry(e.g., predictive analytics, process automation, AI-driven decision-making):?

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*

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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