Speaking Engagement Booking Information Please fill out the form to request a speaking engagement. It will take approximately 10-15 minutes, and gathers information about your event. We will contact you after submission with hiring details and fee information. Step 1 of 5 20% Name * Required First Last Email * Required Phone * RequiredYour Organization * RequiredWebsite or Social Media Link of your Event - enter a valid website URL for example http://www.google.com Event InformationEvent Type * RequiredPlease ChooseVideo/Radio/Social Media ProductionConference/SymposiumKeynoteVisiting ScholarClassroom GuestGraduationRallyOtherYour Goals for this Event * RequiredBriefly describe what you hope to accomplish with this eventDate of Event - must be mm/dd/yyyy format * Required Time * Required : HH MM AM/PM AM PM Location of Event * Required Audience and TopicYour Organization’s Audience * RequiredPlease ChooseEnvironmental ActivistsAdvocacy/Activist educators and leadersCollege/University Student and Campus Life educators and leadersScholarly educators and leadersCollege studentsK12 educators and leadersK12 studentsChurch leadersOtherOther AudienceYour AudienceWhat makes your audience unique? What do you want them to learn?TopicsChoose a topic and give a little more information about the focus of your organization/event. Choose all that apply. Science/Art Collaboration Musicians/Artists and Social Change: Environment and Democracy Musicians/Artists and Entrepreneurship Global Citizenship: Lessons from Travel/Study Abroad Creativity and Innovation in Leadership Disability and Music/Arts Perennialism and Music/ Arts STEM to STEAM- Science Education inspired by the Arts Additional Topic Information Booking DetailsEvent Location * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Preferred Date - must be mm/dd/yyyy format * Required Preferred Time * Required : HH MM AM/PM AM PM Add Alternate Date/Time? Add Alternate Date/Time? Alternate Date - must be mm/dd/yyyy format Alternate Time : HH MM AM/PM AM PM Venue InformationVenueAuditoriumClassroomChurchConference VenueLength of TalkAdd approximate speaking timeAudience Size1-2020-5050-100100+Are LCD projector and speakers that attach a laptop available in the venue?YesNoAdditional InformationDescribe any additional talks/appearances (eg. workshop, media interviews: print, television, radio, social media)
