i would love to partner with you at your next event. please fill out the form below so i can better serve you and meet the goals and objectives of your event.

i will respond to you within 48 hours of receiving your inquiry.

Speaker Inquiry Form

Name

First Name

Last Name

Company/Organization

Email Address

Phone

Website

Billing Address

Date of the Event

Location of the Event

Length of Presentation

Purpose of the Event

Is there a theme or slogan? If so, what is it?

What type of presentation are you interested in?

Keynote Speech

Workshop

Panel Discussion

Emcee

Other

Fee range for Jaisa to speak not including travel (min and max)

Estimated Number of Participants

Age Range & Demographics of Participants

Is there a registration fee for participants? If so, how much?

Will the event be professionally videotaped and photographed?

If requesting a presentation outside of Atlanta, GA, is travel and lodging included? Will ground transportation be provided? What is the closest airport?

Brief description of your needs/topics you would like addressed

Will you allow Jaisa to have a product/information table at the event?

Yes