Speaking Engagement Request Form

Contact Name *

First Name

Last Name

Phone *

(###)

###

####

Will you be charging a registration fee for this specific event? *

Yes

No

Maybe

Will the event be open to the public? *

Yes

No

What type of presentation are you seeking? *

Online/Zoom

In Person

If this is an in-person event, are you able to cover speaker travel expenses (transportation, lodging, meals) for the event?

Yes

No

Maybe

Doesn't apply

If this is an online event, will the presentation be recorded?

Yes--only for membership viewing

Yes--for membership and public viewing

No

Maybe

Not applicable