First & Last Name*

Title*

Company / Organization*

Email*

Phone Number

Location / Time Zone

Best time to call: (ie: AM, PM, mid-afternoon)

Event website / Company website*

What is the name of the event?

Name of venue & address where event will be held.

(blank if location of event has not been set yet)

Proposed date of event

Length of time requesting for me to speak?* (ie: 30 minutes, 60 minutes, half or full day, multi-day, etc)

How many attendees are expected for this event?

Will there be an opportunity for me to sell books/other products at the event?

yesnolet's discuss

Why do you think I'd be a good fit as a speaker for your event?

Is there anything else I should know at this time?

I understand that by filling out this application I am not hiring Priscilla at this moment and am not obligated to pay anything at the time of submitting this form. By filling this out, I am communicating that I am interested in booking Priscilla to speak at my event, that her speaking fees are in the realm of possibility for me and/or my organization and that I'd like to explore her options for working together.

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