DR INGA SPEAKING REQUEST FORM: THE BUSINESS MOGUL

SPEAKING REQUEST QUESTIONNAIRE

Thank you for considering Dr. Inga to speak at your event! Let's start the conversation.
Contact name*

First NameLast Name
Contact Email*
example@example.com
Contact Phone Number*

Area CodePhone Number
Name of Your Organization*
How did you hear about Dr. Inga?*
Name of your event*
Time of your event*

:HourMinutesAM/PM Option
Virtual or Live Event

VirtualLive
Venue Location, If Live:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event Website
Describe the event you wish Dr. Inga to participate in*
How many attendees do you expect for your event?*
How many times do you wish Dr. Inga to speak at your event?*
Event Type
Set Duration (In Minutes)
Additional Speakers, if applicable
Speaking Date(s)*
Speaking Time(s)*
Closest Airport/Station*
Please share any additional pertinent details relevant to your request.
Thank you for filling out this speaking engagement questionairre. We will review your information and get in contact with you soon!
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SPEAKING REQUEST QUESTIONNAIRE