Full Name
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Email
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Phone
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Name of upcoming event
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Date of event
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What type of event
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Virtual
In Person (Live)
Estimated number of attendees
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Provide a brief description of the event and its mission
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What is your budget for hiring a keynote or headline speaker for your event?
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Will travel and hotel accommodations be covered? (just type na if virtual)
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Will Dr. Alicia have the opportunity to sell her products or services?
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Why do you think Dr. Alicia will be a great fit for your event?
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Please provide the names of other people of influence speaking at this event
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Anything else you want us to know?
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Proposed time to connect & speak about the event
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Attach flyer or promotion information
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