Request a Speaker

Speaker(s) You're Requesting(*)

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Your Organization

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Your Name

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Email(*)

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Phone Number(*)

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Event Date (or approximate date desired)

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Number of Days Needed from the Speaker for the Event

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Event Location, City and State or Venue Address

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Please describe what you would like your chosen speaker to do

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Number of Talks Needed from the Speaker

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Anticipated Number of Attendees

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What is Your Budget for the Appearance Fee? (excluding travel costs)

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(*)

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