Speaking Request Form Name of Organization * Point of Contact Name * First Name Last Name Email * Event Details Date * MM DD YYYY Event Type In Person Local (Dallas) In Person Travel Required Virtual Event Time * Event Location * Audience Size * 1-50 51-100 101-200 201-500 500+ Audience Demographic Check all that apply BIWOC Young professionals (20-30s) Mid-career professionals (30s-40s) Entrepreneurs/Small Business Owners Corporate/Industry Professionals Other Speaking Duration * e.g., 60 minutes, 90 minutes Event Budget * Please keep in mind: additional fees will be assessed for events that require travel and lodging. $ Event Details * Main Goal of Event * How will Brittany contribute to your event? * Keynote Training Moderator Panelist Other If other, how would you like Brittany contribute to your event? Topic * Additional Information Thank you!
