* 1. Provide your contact Information:

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

* 3. Check all that interest you

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

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

* 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)

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

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

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