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Public Speaking Requests

Public Speaking Requests

  • Event Organizer

  • (Name, title, email, office phone, cell phone)
  • Event Details

  • Date Format: MM slash DD slash YYYY
  • :
  • (Conference, dinner, small group, etc.)
  • Presentation/Speech Details

  • (Keynote address, roundtable, panel, etc.)
  • (30 minutes, 1 hour, etc.)
    (Will the speech be followed by a Q&A session?)
  • Audience Details

  • (Approximate size of audience. Also briefly describe its make-up and if membership is required to attend.)