Speaker Request Form

Speaker Request Form
Organization Name:*
Contact Person:*
Phone Contact:*
Email:*
Country:*
What is the name of the event?*
What is the date of the event?*
What is the Location of the event?*
What is the format of the event?*

In-personVirtualHybrid
What topic(s) would you like Katherine Alexandria to speak on?*
Who is the target audience?*
How many participants are expected?*
What is your speaker budget or honorarium for this engagement?*
Should be Empty: