Speaker Request Speaker Request Form Step 1 of 4 25% Fierce Freedom requires a minimum speaking fee of $250 + plus travel expenses for all speaking engagements.(Required) I understand the honorarium policy. Event DetailsEvent Name(Required) Organization Running the Event(Required) Event (or Organization) Website Focus / Objective of Your Event(Required) Expected Audience(Required) How many attendees do you expect? What is the makeup of the audience expected to be - professional, law enforcement, church, etc.Event Date(Required) MM slash DD slash YYYY We Would Like the Speaker To Be A(Required) Keynote Speaker Panelist Breakout Session / Workshop Leader Speaker Presentation Time Hours : Minutes AM PM Event Location(Required) Street Address City State / Province / Region ZIP / Postal Code Is the mailing address the same as the event location?(Required) Yes No Mailing Address(Required) Street Address City State / Province / Region ZIP / Postal Code Will audio and video equipment be provided and available onsite?(Required) Yes No Other SpeakersWho else will be speaking at your event? Primary Event Contact InformationPrimary Contact Name(Required) First Last Primary Contact Mobile Phone(Required)Primary Contact Email(Required) Enter Email Confirm Email Media PresenceDo you expect any media will attend the event?(Required) Yes No Expected TV / Radio / Podcasters List the television stations, radio stations and podcast that you anticipate will be at your event.CAPTCHA
