Speaking Request Form

Thank you for your interest in having Patrick speak at your event. A member of our team will review your request and be in touch.

Name of Organization

Contact Name

Conctact Person's Assistant

Assistant's Email

SPEAKING INFORMATION

Name of Event

Date of Event

Type of Event

Recorded Message

Live-Streaming

In-Person

Podcast Guest

Time of Event

Location of Event

Purpose of Event

Type of Organization

Non-Profit

For-Profit

Other

Duration and Schedule of Speaking Times

Length of Talk

Besides the talk, are there any other events/agenda items that Patrick will be required to attend/record?

Past Speakers at this Event

Current Speakers at this Event

Attendee Demographics

Projected Number of Attendees

Theme or Topic that you would like Patrick to Speak on?

Budget for Talk

Additional budget for travel and lodging for two people (if necessary)

Please Correct Errors before submitting this form.