Book us for a Speaking Engagement

Thank you for the invitation to speak at your event. To facilitate our ability to give your invitation full consideration and make a swift decision, please complete the form below at least 3 weeks in advance of the event date.

Organization Name

Organization Website

http://

POC Name

First Name

Last Name

Phone

Country

(###)

###

####

POC Email

Event Name

Event Description

Expected # of Attendees

Event Date

YYYY

Event Start Time

Hour

Minute

Second

Event End Time

Hour

Minute

Second

Virtual Event

Skip this question if the event does not have a virtual presence.

Yes

Event Venue Location

Leave blank if the event is virtual.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Topic of Discussion (22nd & Tech's Topic)

Provide brief description of what topic(s) you want us to speak on. ie, Branding, Technology, Business motivation, etc.

Expected Talk Time for 22nd & Tech

Approximately how would you like us to speak?

Will your organization offer an honorarium?

Speaker Compensation (budget)

Yes

Honorarium

Speaker Compensation (budget)

Will your organization cover travel and lodging expenses?

Skip this question If the event/engagement is virtual or 30 miles within Atlanta, Ga.

Yes

Will the event be professionally recorded?

Yes

How long will the recorded footage of 22nd & Tech be?

If so, who is the point of contact to retrieve professional video and/or photo footage from?

When will footage be available?

Confirmation Deadline

What date will 22nd and Tech be confirmed for the speaking engagement?

YYYY

FB Business Page

http://