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Speaking Request Form

Book Debi to speak at your event

Click the button below to start.

Start

Question 1 of 10

First + last name

Question 2 of 10

Name of your organization

Question 3 of 10

Phone number

Question 4 of 10

email

Question 5 of 10

What is the mission/ purpose of your org?

Question 6 of 10

Anticipated date(s)?

Question 7 of 10

How many people participating/ attending? (ballpark)

Question 8 of 10

What is the ticket price for this event?

Question 9 of 10

Budget for speakers?

Question 10 of 10

Please describe the event (conference, Grand Rounds, etc) + how long the talk will be:

 

Confirm and Submit