Interview / Speaking Engagement Request

Thank you for your interest.
Please note that I am usually booked several months in advance,
so the earlier you submit a request, the more likely I can say yes.

Name of your Organization or Event

Organization / Event Type

Contact Name

Phone number

Email Address

Type of request

Keynote

Panel

Plenary

Online Webinar

Skype / phone interview

In person interview

Other

Date, time and location of event

If this is an interview, and you have flexibility, please clarify the window of opportunity.

What is the subject or focus of your event / conference / magazine / podcast / blog?

How would you describe your audience?

It helps me to know if I will be speaking to mediators, lawyers, community leaders, government officials, activists, parents, psychologists, people with very diverse backgrounds etc. It also helps me to know how many people will be present.

How long would I be speaking / being interviewed?

What would you like me to speak about?

What fees and expenses are you prepared to cover, if any?

Please clarify your capacity and policy. Would you be covering the cost of travels and accommodations, if any are involved? Do you have a budget for Speakers' fees?

Anything else you would like to tell me?