Speaker Request - Jocelyn Gavin-Lane

Speaker Request Form

Name *

First

Last

Street Address *

Street Address (Line 2)

City *

State *

Postal/ Zip Code *

Phone (include area code + phone number) *

Date of Event *

MM/DD/YYYY

TIme of Event *

00:00 AM or PM (Example, 2:00 PM)

Name of Event *

Expected Number of Attendees *

What kind of event? *

What is your Speaker/Trainer budget? *

What kind of appearance would you like Jocelyn to make at your event?

Are there any sensitive issues I should be aware of or topics I should avoid? And if so, what are those topics? *

What are some of the current problems/challenges/breakthroughs experienced by your attendees, industry, organization, association or people? *

What specific topics would you like Jocelyn to discuss? *

Is Jocelyn able to sell products at this event? *

Name