Speaker Inquiry Form

1

What's Your Name?

First Name

Last Name

2

Email

example@example.com

3

Phone Number

Please enter a valid phone number.

4

Organization/Company Name

5

Website/Social Media (if applicable)

6

What is the name of the event?

7

Date of Event

Date

8

Location of EventCity/Venue/Virtual

9

Expected audience size

10

Audience demographic(Age, Industry, Background)

11

What is the theme or focus of your event?

12

What specific topics would you like covered?

14

How long should the presentation be?

15 minutes

30 minutes

60 minutes

90 minutes

15

What is the desired outcome or impact for your audience?

16

Is there an honorarium or speaker fee?

YESNO

17

What is the Budget Range?

18

Will travel and accommodation be covered?

YESNO

19

Will AV equipment be provided?(Microphone, projector, etc.)

YESNO

20

Will the session be recorded or live-streamed?Yes/No and if Yes, for what purposes?

21

Have you booked speakers for this event before?

YESNO

22

How did you hear about me?

23

Is there anything else you’d like me to know about your event?