Speaking & Podcast Request Questionnaire
Thank you for your interest in having Dr. Nicole Roberts Jones as a speaker at your event or on your podcast. Please take a moment to complete the questionnaire and we will get back to you within 24 - 48 hours.
Name
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First Name
Last Name
Company/ Organization /Group
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Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Website address
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Are you requesting Dr. Nicole to speak at your event or as a guest on your podcast?
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Speaker At My Event
Guest On My Podcast
Date of the Event (if podcast write n/a)
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Location of the Event (if podcast write n/a)
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Number of Attendees Expected To Attend Event or Listeners if a Podcast
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Purpose of Event/Podcast: What do you want participants to walk away with?
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Topic of Interest: What would you like Dr. Nicole to speak on?
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Women's Empowerment
Purpose
Leadership Development
Life Balance / Meaningful Work
Entrepreneurship: Business Development or Growth
Tell us more about the topic you are interested in.
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Who is the audience?
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How long would you like Dr. Nicole to speak?
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Is there an event/podcast website? (please include link)
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For Speaking Event: What Is The Honorarium/Speaker Fee?
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For Speaking Event: If this event is outside of the Washington DC area, what expenses have you budgeted for Dr. Nicole's travel, transportation and overnight accommodations?
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Is this a ticketed event? If so what is the ticket price?
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Will this event be recorded?
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If Nicole accepts, we will provide a professional high-res head shot, written and read-it bio for marketing purposes. We do not approve nor authorize any likeness to Dr. Nicole Roberts Jones or Dr. Nicole Roberts Jones photos, videos or content from the public domain (i.e. internet, social media pages, web pages, etc.) Do you agree to honor our request?
*
Please Select
Yes
No
Submit
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