PUBLIC SPEAKING FORM - Bekah Charleston

BOOK BEKAH TO SPEAK

Please fill this form out to book Bekah for a speaking event.

Name(Required)

First Last

Email(Required)

Phone(Required)

Name of Organization(Required)

Your Organization's Website

Tell us about your event(Required)

Who attends? (i.e. titles, affiliations)(Required)

Approximate size of audience(Required)

Will there be a lineup of more speakers or will Bekah Charleston be the only speaker?(Required)

What is the goal of having Bekah at your event?(Required)

Raising awareness

Training

Other

Can Bekah use a PowerPoint presentation? If so, what equipment will be provided?(Required)

Name of Building

Address of Event

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is this event one day or multiple days?(Required)

One day

Multiple days

Multiple days - but we only need Bekah there for one day

Please list days of event(Required)

Please list in this format: mm/dd/yyyy - mm/dd/yyyy)

Date of Event(Required)

Start time of event(Required)

End time of event(Required)

When should Bekah arrive?(Required)

What time would Bekah speak?(Required)

How long does Bekah have to speak?(Required)

Budget or honorarium offered(Required)

Additional notes

Tell us how you heard about Bekah Speaks Out and who we can thank for this opportunity to share at your event.(Required)

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