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Speaking Request Form

Thank you for your interest in having
Ariel Thee RDH speak at your event!
Please complete the following survey and we'll
respond to your request as soon as possible.
Thank you!
1.Describe the Speaking Engagement
  Please include in your response:
    1. Contact Information; First & Last Name, Company, Title in Company, Telephone #, Email & Website 
    2. Event Host's Name/ Company Hosting Event
    3.Event Title, Date(s) & Time(s) 
    4.Location of the Engagement
    5.Purpose of the Event (Required.)
2.Please provide the length of time you would like Ariel to speak:(Required.)
3.What would you like attendees to take away from this engagement?(Required.)
4.Please describe your audience demographic (i.e. age, geographic region, psychographic profile, etc):(Required.)
5.What is you speaking budget range?(Required.)
6.Is this the first time you are hosting this event?
(If no, how many attendees did you have at the last engagement?)(Required.)
7.How many attendees are projected to come to this requested engagement?(Required.)
8.Please describe your marketing plan to fill the event:(Required.)
9.Are you selling products or programs at the event?(Required.)
10.Will Ariel Thee RDH Co. be permitted to sell our products and programs at the event?(Required.)