Full Name

Title

Organization

Email Address

Contact Number

Title, Date, Time & Location of Your Event (If your date is flexible, please share date options for consideration).

What type of presentation are you requesting What type of presentation are you requesting Keynote Workshop Panel Training Mistress of Ceremony Facilitation Media Interview Virtual Presrntation Other

Requested Presntation Length Requested Presntation Length 1-2 Hours Half Day Full Day Multi-Day Other

Is this a first time event? If no, briefly describe event history.

Describe your target audience.

What is the anticipated number of attendees?

What does success look like for your event?

Will the event be recorded?

What is your Speaker Budget?(Please explain in detail, taking into consideration Dr. Grant's Speaker Rates)

If you do not have the capacity to cover her standard fees, are you able to cover her round trip travel and accommodations to support your event? If yes, please provide proposed options.

Is there any additional information you would like to share about this event?

Are you interested in purchasing bulk copies of Dr. Grant's book for participants in advance of this engagement? Are you interested in purchasing bulk copies of Dr. Grant's book for participants in advance of this engagement? Yes Maybe, let's discuss more Not at this time

Will Dr. Grant have the opportunity to sale her products and services at the event? Will Dr. Grant have the opportunity to sale her products and services at the event? Yes N0