SPEAKING REQUEST FORM Please submit all of the details of your event request below. (Note: Only a representative capable of making contract decisions for your organization should complete this form.) Please do not use this form for submitting media / interview requests. Instead, use the Media Request Form. Contact InformationContact Person*TitleEmail* Organization*Event InformationEvent location (City, State, Country)*Venue (if known)Closest airport(s) to your venue / city*Anticipated attendance (how many people do you expect at this event and what demographics make up your audience)*Proposed dates for your event (please list all possible options for us to consider)*Time of event Morning Event Luncheon or Afternoon Event Dinner or Evening Event All Day Event Multi-Day Event Other In what capacity can Jen best serve your event? (Please select all that apply.) Keynote Speaker Seminary / Session / Workshop Leader Q&A Session Interview Meet & Greet / Book Signing Lunch, dinner, or other private gathering with your event team, board members, or other VIP guests Other Please provide an estimate of your organization's budget for the speaker's honorarium and travel expenses*Are there any other details we should know about your organization or event?NameThis field is for validation purposes and should be left unchanged.