Speaker Request

Speaker Request FormPlease enable JavaScript in your browser to complete this form.

Name *

FirstLast

Organization/ Group *Email *PhoneWebsite *Event Name *Event Purpose *

Event Type *

Event WebsiteEvent/ Recording Date and Time *Please include your time zoneIs There Flexibility on Date & Time? *

Event Location *

Budget *Estimated Number of Attendees *Audience Member Type *Desired Topic You'd Like Mel to Speak On *Length of Talk *

Type of Presentation *

Additional Information You'd Like to Share

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