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Speaker Request Form
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Email:
Contact Name:
Contact Phone:
Event Name:
Date of Event:
Presentation Start Time:
Presentation Length:
Event Address/Location:
Presentation Type:
Keynote
Address
Guest Speaker
Breakout
Panel Discussion
Workshop
Facilitator
Presentation Title:
How did you hear about
?
Website
Facebook
Instagram
Referral
LinkedIn
Other
Audience Analysis:
Overview of Audience (career professionals, entrepreneurs, moms, etc.)
Audience Age Range:
What goals or objectives do you want the presentation to address?
How do you want the audience to feel after the presentation? (ex. inspired, informed, educated , etc.):
Speaker Budget:
Will
be allowed to promote any products/services?
Yes
No
Let's Discuss it!
Will travel accommodations be needed? Please keep in mind we are in the Atlanta area.
Yes
No
N/A
Any Additional Comments:
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