Speaking and Workshop Request
Submit your event details to request a keynote, workshop, or facilitation session tailored to your audience and goals.
Name
*
First Name
Last Name
Email
*
example@example.com
Organization Name
*
Event Title
Event Date
*
-
Month
-
Day
Year
Date
Session Type
*
Keynote
Workshop
Retreat
Facilitation
Panel
Other
Audience Size
Form
*
In-person
Virtual
Topics of Interest
Additional Notes or Expectations
Submit any relevant documents.
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Consent Agreement
*
By submitting this form, I consent to the collection and use of the information provided for the purposes of communication, resource delivery, and service engagement with Gerron Scott Consulting. I understand that my data will be handled securely and will not be shared or sold to third parties. I may withdraw my consent at any time by contacting info@gerronscott.com.
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