Name*

Event or Organization Name*

Email*

Phone*

Location of Event*

Event Date*

Web Page for Event

Type of speaking opportunity*
KeynoteWorkshop/Breakout SessionPanelVirtual EventOther

Expected number of attendees*
[text*Number class:std_input class:std_input]

Do you have a budget?*
Yes, speaker fee plus travel expensesWe have a moderate budgetStipendNo budget, but awesome exposure

How did you hear about Stephanie Chandler?*
Read your booksGoogle searchSocial mediaBusinessInfoGuide.comReferralAttended one of your eventsArticle/media storyOther

Description of event and speaker requirements*

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