Speaking Request Application

Thank you in advance for taking the time to tell me about your event!

Please complete the form below by choosing appropriate boxes of interest to you and your organization. My team will get back to you shortly with next steps.

First Name

Last Name

Phone *

Email *

Organization

Event Name

Event Date *

What date is your event?

Event Location

City, State or Virtual

Expected Audience Size

Who is the Audience?

Executive Directors

Development Staff

Board Members

Mixed

Desired length of presentation

Will AV equipment be available (if in person)?

Yes

N/A

Are books/workbooks desired as part of the package?

Will travel and lodging be covered (if in-person)?

What's the biggest challenge your audience is facing right now?

Is there anything else you would like to share with Mary?