Provide your contact Information:

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* 1. Provide your contact Information:

Please describe your current position and provide brief work history

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* 2. Please describe your current position and provide brief work history

Check all that interest you

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* 3. Check all that interest you

List any recent publications/presentations you have done recently.

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* 4. List any recent publications/presentations you have done recently.

List a reference that has listened to one of your presentations

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* 5. List a reference that has listened to one of your presentations

Describe your area of expertise, your signature talk - the more information you can provide about your niche and ideal audience the easier it will be for us to book business for you.  Please include website and link to video (promo reel)

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* 6. Describe your area of expertise, your signature talk - the more information you can provide about your niche and ideal audience the easier it will be for us to book business for you.  Please include website and link to video (promo reel)

What price range would you say your speaking engagements are at currently?

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* 7. What price range would you say your speaking engagements are at currently?

Last but not least, if we sign with you today, do you have a Press Kit and Highlight Reel ready to go?

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* 8. Last but not least, if we sign with you today, do you have a Press Kit and Highlight Reel ready to go?

How did you hear about Karie Millspaugh/our company and speaking opportunity?

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* 9. How did you hear about Karie Millspaugh/our company and speaking opportunity?

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