Conference Request
Please complete to request Jacqueline Twillie to speak at your conference or event by filling the form below, specify the expected number joining the conference.
Point of Contact Phone Number
*
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Area Code
Phone Number
Point of Contact Full Name
*
First Name
Last Name
Main Point of Contact E-mail
*
Conference / Event Date
*
-
Month
-
Day
Year
Date
Event Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Estimated Number of people attending
*
Event website
What is the cost for attendees to attend?
*
Will the event be recorded?
Yes, livestream included
No, livestream will NOT be included
Yes - for future use
No
Other
Type of Presentation Requested
*
Keynote (60-90 minutes)
Panel
Break out session (30-90 minutes)
Other, please leave details below
Other
Budget for requested Presentation Type
*
Jacqueline's commitment to equal pay for women extends to speaking events as well. Therefore, request for non-paid presentations is limited.
Additional Details related to event
Register
Should be Empty: