First Name (Requester) *

Last Name *

Phone *

Email *

Organization/Company Name *

LinkedIn or Website URL (optional)

If Other, please list here

Name of the Event / Project *

Describe the Vision in One Bold Sentence (Short answer) *

Example: “We’re bringing together barrier-breakers to ignite bold leadership in underrepresented industries.”

What Makes This Opportunity Powerful or Different? (Paragraph) *

How will this elevate the audience, change the narrative, or disrupt the norm?

Event/Opportunity DATE *

Time & Time Zone *

Location (Virtual or In-Person, City & Venue if applicable) *

What Are You Asking Christopher to Do? *

Ex: 20-min keynote, 45-min panel, full-day co-host, strategy session, brand activation partner, etc.

Compensation or Budget *

Paid Opportunity

Partnership / Co-Creation

Unpaid (please explain why below)

Christopher brings strategy, story, and substance. What’s the honorarium or partnership value?

If known, please share the budget amount or structure: *

Why Christopher? Why Now? *

Why do you want Christopher involved in this moment or movement?

Any Additional Notes or Links?

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