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Book Us to Speak Form

Basic Event Details

Name of the event or conference.

Host or organizing body.

Link to event information page

Include start date.

Provide the end date if multi-day event.

Location

City/State or Virtual/Hybrid


Contact Information

For follow-up and confirmation

Optional for quick contact.

Speaking Opportunity

Please describe.

e.g., nurses, students, 150 attendees, etc.

Preferred Length of Talk
Speaking Format
Presentation Time
Time
HoursMinutes

Please include time if agenda is already scheduled.

Honorarium / Budget

Speaker Fee or Honorarium Available?
Option 1 Yes
Option 2 No
Option 3 Other
Other

Helps clarify expectations.

Honorarium Amount
$

Logistics & Support

Travel/Accommodation Covered?
Option 1 Yes
Option 2 No
Option 3 Maybe
AV or Tech Support Provided?
Option 1 Yes
Option 2 No

Please check if virtual or hybrid.

Additional Information

How did you hear about us?

Allows upload of supporting materials such as agenda, flyer, etc. and accept .docx or .pdf formats.

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