Thank you for considering me for your next event!
Please fill out this short application to tell me a little bit more about your public speaking needs.
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Your Name *

 
Contact Number *

 
Company or Organization *

 
Date of event

Leave blank if TBD
 
Estimated number of attendees *

 
In what capacity are you considering hiring me? *


 
What kind of group is it? *


 
Give me a brief description of the event and topic you'd like me to address. *

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