Speaking Engagement Request | Martell Collins / Build Where You Live
Thanks for your interest in booking Martell Collins. Complete this short request before choosing a planning-call time. Your responses help Martell understand your organization, audience, goals, and event needs before the conversation.
Organization Contact Information
Organization / School Name
*
Contact Person Full Name
*
First Name
Middle Name
Last Name
Job Title / Role
*
Email
*
example@example.com
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Organization Website
Organization and Event Details
Type of Organization
*
Please Select
School
Nonprofit
College/University
Government
Business/Corporate
Community Organization
Other
Event Type
*
Please Select
Keynote
Interactive Workshop
Panel
Assembly
Professional Development
Youth Engagement
Other
Preferred Event Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Alternate Date(s)
Event Location / Venue and City
*
Event Format
*
In-Person
Virtual
Hybrid
Estimated Audience Size
Audience Age Range / Grade Level
Estimated Length of Engagement Requested
*
Engagement Goals and Context
Primary Topic or Theme Requested
*
Goals or Desired Outcomes for This Engagement
*
Why Are You Interested in Inviting Martell Collins / Build Where You Live?
*
Audience Considerations, Accessibility Needs, Sensitive Context, or Special Requests
How Did You Hear About Martell?
Please Select
Referral
Social Media
Website
Event or Conference
Podcast
News or Article
Colleague
Other
Standard Keynotes & Interactive Workshops are $1,399. Does this align with your current budget?
*
Yes
Need to Discuss
No
Anything Else Martell Should Know Before the Planning Call?
Submit Request
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