Booking Request

First Name *
Last Name *
Email *
Your Relationship to Organization
Street Address 1 *
Street Address 2
State/Province *
Country *
Zip/Postal Code *
Tell us briefly about your Group/Organization?
What is the purpose of the event? *
What is the topic would you prefer? *
What are you hoping I might bring to the event? *
Might it be possible for me to have access to Audio/Visual support for PowerPoint and Video? *
  Please Indicated Below if Applicable:
What is the estimated attendance? *
To be handled by our organization (host)
This is a private event

This is an open event to the public. Registration and logistics will be handled by our organization (host)

Yes, I'am aware that speaker fee is contractual. Speaker fees can be addressed by calling for consultation, and you may contact us by email for the best time to speak with point of contact.

Yes, I'am aware that travel and lodging expenses for my booking are the responsibility of the host. Arrangement will be discussed during consultation and finalize at the time that deem to meet your request requirements.