JULO Speaker Request Form

Book Juliann Nichols to Speak

Thank you for your interest in having Juliann speak at your event. Only a few questions are required. Share what you know now, and we will fill in the rest together.
Event & Organization Details
1. Organization Name:Please provide the official name of your organization.
2. Contact Name:Who will be the primary point of contact for this event?
3. Contact Email:Provide the email for the main contact.
example@example.com
4. Contact Phone Number:Best number to reach you.
Please enter a valid phone number.Format: (000) 000-0000.
5. Event Title:What is the name of your event?
6. Event Date(s):Please include all dates relevant to the event.
7. Event Time(s):Specific times for the keynote, breakout sessions, and networking events.
8. Event Location (City/State/Country):Please provide the full address if known.
9. Event Format (In-Person/Virtual/Hybrid):Select one.

Other
10. Estimated Audience Size:Approximate number of attendees.
11. Audience Demographics:Who will be attending? Please include job roles, industries, and any other relevant details about your audience.
12. Key Event Goals:What are the main objectives of this event?
Speaking Engagement Requirements
13. Type of Engagement (Select One or More):

Other
14. Expected Duration of Keynote/Speaking Segment:Please indicate the estimated time (e.g., 30 mins, 1 hour, 90 mins).
15. Which talk interests you?
16. Other Topics or Themes:Anything specific you would like Juliann to cover or emphasize?
17. Additional Activities or Engagements (if any):

Other
Event Logistics & Technical Requirements
18. AV Requirements and Equipment Provided:Please include details about the stage setup, microphone type, projector, screen, etc.
19. Expected Arrival/Departure Dates and Times (for In-Person Events):Include any required travel days if applicable.
20. Venue Details and Accessibility (for In-Person Events):Include information about the venue size, layout, and any travel or accommodation arrangements.
Budget & Financial Details
21. Speaker Budget Range:Please provide an approximate budget for this speaking engagement.
22. Will Travel and Accommodation Be Provided?

Other
23. Any Other Expenses Covered (meals, ground transportation, etc.)?Please specify what costs will be covered by the event organizers.
Marketing & Promotion
24. Will Juliann’s Presentation Be Recorded or Livestreamed?
25. Will the Presentation Be Used in Future Marketing Materials by the Event Organizer?
26. Will the Event Be Promoted on Social Media and Other Platforms?Please include details on how the event will be marketed.
Additional Information
27. Is There Anything Else We Should Know to Tailor This Experience?Please include any special requests or additional information.
28. How Did You Hear About Juliann Nichols?

Other
Text messages (optional)
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Thank you! Juliann will personally review your request and be in touch to talk through next steps.

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Book Juliann Nichols to Speak

Event & Organization Details

Speaking Engagement Requirements

Event Logistics & Technical Requirements

Budget & Financial Details

Marketing & Promotion

Additional Information

Thank you! Juliann will personally review your request and be in touch to talk through next steps.