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Request a Speaker

For help finding the perfect speaker for your upcoming seminar, conference or educational event, please fill out the form below as completely as possible and submit it electronically.  Upon receipt, Dave Parlin will contact you by phone with suggestions for speakers.

* REQUIRED FIELDS

*Name:

*Title:

*Organization:

*Address:

*City:

*State:

*Zip:

*Phone:
(No Hyphen or Parentheses)

Fax:

*E-mail:

Event Information

*Type of event:

*Number of attendees:

*Date(s) of event:

*Are you able
to change the date(s)?

Yes No

*Time of day of speaking engagement:

*Location of event (City, State):

*Closest recommended commercial airport:

We are looking for a...

Keynote presenter
Breakout presenter
Presentation moderator
Group facilitator

*Please indicate the length (in hours)of the presentation/
facilitation:

hours

*Are you looking for a speaker to present multiple sessions?

 Yes  No

*Please indicate your budget
allocation for a single speaker:

$2,500 - $4,999
$5,000 - $7,499
$7,500 - $9,999
$10,000 and above

Comments and Topic Areas:
Please indicate the major focus of your event, and the topics/challenges that are of greatest interest to your organization. Please include any additional information about your event that will help us make the best speaking recommendation.