SPEAKER INTEREST FORM

Thank you for your interest in having Chéri S. Allen speak at your event! Please complete this form to provide the details needed to evaluate if "The Cost of the Cape" keynote would be a good fit for your audience.

Event Details

Event Title *

Event Date *

Event Time *

Event Location *

Is this a paid speaking opportunity? *

Audience Information

Audience Description *

Expected Number of Attendees *

Speaking Engagement Details

Preferred Talk Duration *
Please select 45 mins 60 mins 90 mins 2–3 hours Other

If "Other" duration, please specify:

Expected Outcome or Goal of Talk *

Potential Future Opportunities

Contact Information

Organization Name *

Contact Person Name *

Contact Email *

Contact Phone Number *

Additional Information