Booking Request

Full Name*

Email Address*

Company/Organization

What are your proposed event dates?*

What Is your event title?

What is the event address?

What is the theme of this event and topic of discussion?

What is the expected talk time? (If Applicable)

Who is the expected audience?

Are There Any Additional Speakers/Officials Attending This Event?

Yes No

If so, what are the speakers/officials names?

How many attendees/guests are expected to attend this event?

Please provide the name of who will be introducing the speaker:

Please list the Sponsoring Organization's Info (Name of contact, Email Address, Mobile Number/Office Number)

What is your budget for: speaking, music/entertainment for the event?

If selected "Other", for bugdet, What is that budget?

If the event is in a hotel, what is the hotel name?

Will there be an opportunity or availability for Kirstie to have any of her materials/merchandise for purchase at this event?

Yes No

What audio-visual equipment is available?

Will there be hotel and travel accommodations provided if needed? (If Yes, for up to how many people?)

Book A Request