Speaker Requests

Prefix

First Name *

Last Name *

Title/Position/Organization *0 / 180

Email Address *

Phone Number *

Mailing Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Event Name *

Event Date(s) *

Event Location *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone *

Please describe the mission, purpose, and history of the event *

Anticipated Attendance (insert number) *

Please help Keisha better serve you by describing the diversity (gender, age, ethnicity/people groups, etc.) of the audience. *

What type of sessions would you like Keisha to participate in? *Keynote SpeakerWorkshop Presenter/FacilitatorLeadership TrainingConsulting

Is there a specific topic you have in mind for Keisha to share? *

How will this event be publicized? (Please include social media, website, partners, etc) *

How did you hear about Keisha? *

What honorarium are you prepared to offer Keisha? (Note: Please provide information in U.S. Dollar amounts.) *

Is there anything else we need to consider concerning the request, event, vision, or audience? *

Book Keisha Edwards: Speaker Request Form