MJM SPEAKING REQUEST QUESTIONNAIRE

1

Contact name* This field is required.

First Name

Last Name

2

Contact Email* This field is required.

example@example.com

3

Website* This field is required.

example@example.com

4

Contact Phone Number* This field is required.

Area Code

Phone Number

5

Name of Your Company or Organization* This field is required.

6

Is your organization a for profit or a non-profit?* This field is required.

7

Name of your event* This field is required.

8

Event topic or theme* This field is required.

9

Describe the event you wish Michelle to participate in* This field is required.

10

How many attendees do you expect for your event?* This field is required.

11

How many times do you wish Michelle to speak at your event?* This field is required.

12

Is this a live event, virtual event, or both?* This field is required.

13

Speaking Date(s)* This field is required.

14

Speaking Time(s)

15

What is your budget for your speaker?* This field is required.

$1,000 - $5,000

$10,000 - $15,000

$5,000 - $10,000

$15,000 - $20,000

$20,000 - $25,000

$25,000 and up

16

Additional Information:

We request a 4 or 5-star full-service hotel.

Please provide two non-stop flight tickets - one for the speaker and the another for a traveling companion.

Please provide ground transportation to and from the airport and provide all contact information to Atavia Barnes.

Please provide a table for products.

If the session is recorded, please give a copy to someone on our team.

Upon receipt of your submission, we will contact you if we have any additional questions or together. If your unable to provide any of the request above, please let us know. Thank you for considering Michelle J. Miller for your event.