Speaker Request Form

I look forward to working with you and/or your organization to provide an inspiring and educational experience! 

Speaker requests should include:

  • Roundtrip Transportation (Flight or Car Rental w/gas allowance)
  • Hotel /Lodging  
  • Meals, Registration & Exhibitor Fees 
  • $1000 - $1500 honorarium
  • Assistant may travel with speaker (lodging required)
  • Provide 4-6ft table for the sale of products & services
  • Custom Workshops & lectures are available 

Name:
Phone: :
Email: :
Lecture Interest? :
How did you hear about us?:
Do you have a special request?:
 

 

 

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