Contact Information

Full Name *

Organization

Phone *

Email *

Event Details

Event Name & Description *

Event Date(s) & Location

Expected Audience Size

Audience Profile (e.g., executives, professionals, entrepreneurs, students)

Speaking Role Requested

Select Role

Other (please describe)

Topic Alignment

What theme, topic, or message would you like Dr. Randee to address? 

Budget & Logistics

Do you have an allocated speaker budget?

Yes

Not at this time

If Yes – please specify range: ________

Will travel, accommodations, and event expenses be covered?

Yes

Technical Setup Available (AV, stage, virtual platform, etc.)

Yes

Please share any other details, expectations, or decision timeline.