Speakers Request
Please take a moment to fill out the form.
Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Date of the event
Preferred Type of Speaking
*
Keynote
Half day training
One day training
Two days Training
Other
Your Speaker's fee Budget (Mandatory) If there this field left empty we can't process your request
*
Will you pay for travel?
Is this a grant?
Yes
No
Your Billing Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Time of Timea Nagy's Presentation
Hour Minutes
AM
PM
AM/PM Option
Number of Audience
*Up to 100 attendees Timea's Cause will provide the platform, over 100 attendees please inquire
Ticket Price
Website link for your organization/previous events
Are there Sponsors or Grantors funding this event?
How did you hear about Timea Nagy?
Your goal with this presentation
Inspirational
Raising awareness
Training
Community Building
Facilitating
Submit Form
Should be Empty: