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13
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1
Today's Date
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2
Contact Person
First Name
Last Name
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3
Contact Email
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example@example.com
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4
Name of your Organization
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5
Phone Number
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Area Code
Phone Number
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6
What is the approximate DATE of the event you want Setema to speak at?
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Date
Month
Day
Year
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7
Or if you don't have an exact date, what month and year is the event tentatively scheduled for?
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8
What city and state is the event at?
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9
How many people will be in attendance?
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Less than 50
50-250
251-500
501-1000
1000+
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10
Who will be in attendance at this event? (Mark all that Apply)
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Youth/Church
Sports team/Athletes
Oranization Leaders
Entrepreneurs from different companies
Sales Professionals
Other
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11
What is the purpose of the event? (Mark all that Apply)
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Inspire and Motivate
Get better results
Set new goals and action items
Increase sales and performance
Reset and Recommit to Results
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12
How did you hear about Setema Gali as a Keynote Speaker/Presenter?
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Instagram
Facebook
LinkedIn
Saw/Heard him speak at conference
Referred by a friend
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13
Do you have a budget to hire a Speaker?
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Yes
No
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