Thanks for your interest in having me speak at your event! Please complete this short form so we can see if this is a great fit—and I’ll be in touch soon! 💌

First Name *

Last Name *

Phone *

Email *

Event Name *

Name of Organization/Company *

Event Website or Link (If Applicable)

Event Date

Event Location *

Is this event open to public or private closed group?

Who is your target audience? *

Audience Demographic or key details I should Know to prepare the speech and topic (ie. Age range, industry, level of experience, etc) *

Approximate Number of Attendee or listeners *

What topic(s) or theme did you had in mind that you would like me to speak on? *

How long would you like the session to be? *

What is your budget range for speaker?

IS there anything else I should know to make your event/show a success for you?

How did you hear about me?