First Name *

Last Name *

Organization

Phone *

Email *

Please provide your Instagram and Facebook profile URL's. *

Website *

Desired Speaking Event *

Can you tell us more about the event?

Please describe your event in detail *

What is the length of the event? *

What is the topic of the event? *

Can you explain your ideal audience? What are they looking to learn from your event? *

Where is this event being hosted? *

Will there be ticket sales for this event? *

YES

NO

How many people do you expect to attend the event? *

Will this event be recorded? *

YES

NO

Is this event out of the state of PA? *

YES
NO
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Link to the upcoming event or past events you've hosted *

Pictures or recap videos of any past events you have done *

Press, write-up, or interviews that may have been written regarding any past related events? *

Other speakers or presenters participating in this event

Do you have a venue the event will be held at you can share with us?

What is your speaking budget? *

$

How long are you needing/slotting Herman to speak?

Do we have the opportunity for vending or having an information/merchandise table at the event?