KIDPOWERLEADERSHIP Founder. Speaker, Producer & Author

Speaking/Workshop Engagement Request Form

Name Of Organization *

Organization Address #1 *

City *

State/Province *

Zip Code *

Country *

Contact Name *

First

Last

Contact Title *

Organization Phone Number *

Contact Email *

What is the Name of the Event? *

Complete Address for the Event *

What is the Date, Time and Length of the requested speaking/workshop engagement? *

What is the closest airport and travel time to event location? *

Please provide a description of the audience and expected attendance. *

What is the requested topic or purpose of speech? *

Comment or Message *

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