Speaker Request Form – Julia Westfall

Requesting Organization*
Type of Organization*
- For Profit
- Non Profit
Website Address*
Type of Event*
Location of Event*
Address of Event*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Theme for Event*
Theme for Speaker*
Date of Event*
MM slash DD slash YYYY
Time of Event*

: Hours

Minutes

AM/PM
Time Speaker would Speak*

: Hours

Minutes

AM/PM
Length of Talk*
Expected Attendance - number*
Profile of Attendees*
Authorizing Party Name*
Authorizing Party Title*
Primary Contact*
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Additional Terms:
This is an invitation, not a contract.

Speaking Fees
Small non-profit entities anywhere INSIDE of the 48 contiguous United States - $1,500 - $3,500

For-profit entities, large nonprofit orgs, national / international conventions, etc. INSIDE of the contiguous 48 United States - $5000

For-profit entities, large nonprofit orgs, national / international conventions, etc. OUTSIDE the contiguous 48 United States - $7500

The requesting organization provides air travel, hotel accommodations and meals, if applicable
In circumstances where the requesting party seeks a partial or full waiver of any speaking fees, please note your extenuating circumstances here:
*
- By submitting this I consent to being contacted by Hera Hub and having my information stored by Hera Hub

Additional Terms: