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SPEAKER REQUEST

FILL OUT THIS APPLICATION FORM

    Full Name

    Phone Number

    Business Description 1-3 Sentences (who you help, what, how, how much)

    SPEAKING ENGAGEMENT DETAILS
    Describe the Event in Detail*

    How will This Content be Distributed?

    Audience Size/Downloads/Views of Your Average Event/Podcast/Videos?

    Date of Event/Speaking Engagement

    I understand that in exchange for speaking services, the Event Organizer Fee of $100,000 50% due at signing and 50% due 2 weeks prior to event date. All payments are in US dollars. The Company may cancel any time until the final payment has been made. Should the speakers become ill or unable to attend for other reasons, all fees will be returned.*