Speaking Engagement Request Form
Name
*
First Name
Last Name
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Organizational Affiliation
*
Event Venue/ Online or In-Person?
*
Please Select
Online - Zoom or Teams
In Person
Venue Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Event Duration/ ex: 30 minutes, 45 minutes ?
Desired Topic of Speaking Engagement
*
Please Select
Speaking Engagements - Keynote Address 60-90 mins
Speaking Engagements - Conference & Breakout Sessions 45-60 mins
Professional Development Workshops - Half-Day Workshops (3–4 hrs)
Professional Development Workshops - Full-Day Workshops (6–7 hrs)
Facilitation & Coaching (Strategic Planning, Ongoing Educator Coaching, and Accreditation & Curriculum Review)
Specialized Programs (Student Enrichment, Parent & Family Engagement, and Grant Writing & Resource Development)
Strengths Quest
Suggested dates for your event
*
Are these dates flexible?
Will you charge a fee to attend your event ?
*
How many are expected to attend your event?
*
How did you hear about our program?
*
Website
Youtube
Word of Mouth
Social Media
Other
Additional information or documentation about the event
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