SPEAKING REQUEST PAGE

Contact Person*

Contact Phone*

Email*

Title

Organization*

Please provide active social media links for your organization. *

Venue (or Virtual Platform)

Event location (City, State, Country) *

Closest airport to event (if applicable)

Expected attendance (how many people do you expect at this event? Please also describe the demographics of your expected audience).*

Please provide an estimate of your organization's budget for the speaker's honorarium*

Event Date (please list all possibilities and options for consideration)*

Time of event * Time of event * Morning Event Afternoon or Lunch Event Evening or Dinner Event All Day Event Multi-Day Event Other

Please describe the capacity in which you're interested in working with Brian at your event? (Select all that apply.)* Please describe the capacity in which you're interested in working with Brian at your event? (Select all that apply.)* Keynote Speaker Q&A Session Interview Meet & Greet Lunch, dinner, or other private gathering with your event team, board members, or other VIP guests Other

Please provide any additional details we should know about your request, your organization or your event?