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Speaking Inquires and Facilitator Requests.

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Question 1 of 17

First and Last Name

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Question 2 of 17

Email

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Question 3 of 17

Contact Number

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Question 4 of 17

Organization Name

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Question 5 of 17

Event Name

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Question 6 of 17

Event Date

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Question 7 of 17

Type of Event

A

In-Person Keynote

B

Virtual Keynote

C

Panelist

D

Workshop

Question 8 of 17

Event Location (address or link to venue)

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Question 9 of 17

Expected Length of Speaker Talk/Presentation

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Question 10 of 17

Estimated Number of Attendees

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Question 11 of 17

What is the expected outcome of this event?

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Question 12 of 17

Asiyah Muhsin's current speaker rate range is $5,000 to $10,000 (NOT including travel and lodging). Does this fit within your budget?

A

Yes

B

No

Question 13 of 17

A 50% deposit is required to secure your date. The balance is due 7 days prior to the event. Payments are only accepted via credit card or ACH bank transfer. Do you agree to this?

A

Yes

B

No

Question 14 of 17

Will your organization cover travel expenses including airfare (if applicable), ground transportation, and lodging?

A

Yes

B

No

Question 15 of 17

Will this event be professionally photographed and/or video recorded?

A

Yes

B

No

Question 16 of 17

Will you provide Asiyah Muhsin with a copy of photos and videos for her use?

A

Yes

B

No

Question 17 of 17

Please share how you learned of Asiyah Muhsin?

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