Name * First Name Last Name Email * Contact * (###) ### #### Organization Name Event Name * Event Date * MM DD YYYY Event Time Hour Minute Second AM PM Event Type * Virtual In-Person Event Location For In-Person Only Discussion Expectations * Length of Talk * Expected Number of Audience * Demographics of Audience * What would make this talk a success, when taking into account the audience and organization? * What is your budget for the event? * Will your organization cover travel and lodging expenses? * Yes No Will the event be recorded professionally * Yes No Will the event be professionally photographed? * Yes No Thank you!I look forward to working with you and will return your inquiry within 24 hours. Myia