Speaker Request Form for Tiffany Lewis

Speaker Request Form

Thank you for considering Tiffany Renee’ Lewis for your upcoming event. To begin the booking process, please complete the form below. Our team will connect with you within 48 hours to confirm availability, discuss honorarium details, and outline next steps.Tiffany brings powerful expertise in youth empowerment, women and girls’ advocacy, faith-rooted resilience and transformation, confidence building, identity development, and organizational leadership.
Organization/School/ or Company Name*
Your Name*

First NameLast Name
Your Contact Email*
example@example.com
Your Contact Phone Number*
Website (if applicable)
Event Name*
Event Description (Purpose, theme, audience goal)*
Date of Event *

MonthDayYear
Date
Event Time*

Hour Minutes

AM/PM Option
Is this date flexible?*

YesNo
Event Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Expected Number of Attendees*
Audience Type:*
Requested Services*
Dress Code/Attire for Event*
Is There a Speaker Budget Allocated?*

YesNo
If yes, please share your honorarium range:*
Will Hotel and Travel Expenses be Reimbursed?*

YesNo
Will Tiffany's paticipation be used for promotional materials?*

YesNo
How Did You Hear About Tiffany Lewis?*

ReferralSocial MediaWebsitePast EventOther
Anything else we should know to make your event a success?
ACKNOWLEDGEMENT

Submitting this form does not confirm booking. A member of our team will follow up within 48 hours with availability, fee confirmation, and next steps.
Signature

Powered by Jotform SignClear
Should be Empty: