Speaking Request - Jess+TheMess

Contact Person

First

Last

Title

Email

Organization

Event location (City, State, Country)

Venue (if known)

Closest airport(s) to your venue / city

Anticipated Attendance

(how many people do you expect at this event and what demographics make up your audience)

Proposed dates for your event

(please list all possible options for us to consider)

Time of Event

In what capacity would Jess participate in your event?

(Please select all that apply.)

Budget for honorarium and travel expenses

Please provide an estimate of your organization's budget for the speaker's honorarium and travel expenses

Other Information

Are there any other details we should know about your organization or event?