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Host Name *

Phone *

Event Name *

Email Address *

Website

If virtual, Event Platform?

If in-person, Event Location?

Event Begin Date and Time *

Event End Date and Time *

Requested Date and Time - You Would Like Dr. Taylor to Speak *

How long would you like Dr. Taylor to Speak? *

What topic or theme would you like for Dr. Taylor to speak on? *

Type of EventConferenceWorkshopSeminarEmceeingPanelOther

If you selected "Other" for the previous response, please give more details here.

What is the purpose of this event? What is your desired outcome? *

Anticipated Audience Size? *0-5051-250251-500501-1000

Estimated Speaker Budget *Note: In addition to your speaking budget, please consider Dr. Taylor's required air travel, ground travel, and lodging expenses for the duration of the engagement if the event is in person and outside of the Dallas/Fort Worth area.

Contact Person Full Name *

Contact Person Email Address *

Contact Person Phone Number *

Will there be a table available for her product and material? *YesNo

Are there any other details you wol dike to share about your event?

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YES PLEASE!

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Home
About
Shop
- Merch
Agency
Coaching
- Courses
Speaking
Contact

Home
About
Shop
- Merch
Agency
Coaching
- Courses
Speaking
Contact