Dr. Perkins Speaking Request Form Thank you for your interest in inviting Dr. Perkins to SpeakPlease complete the form below: Contact Information Primary Contact Name* Primary Contact Number* Primary Contact Email* Primary Contact Position Your Organization Organization Name Type of Organization Organization Website Your Event Name of Event* Date of Event* Location of Event* Type of Event In-personVirtual Theme/Purpose of Event* Proposed Topic for Speaker* Presentation Format (panel, speech, roundtable, etc.) Presentation Details (Length, Q&A, etc.) Speaker Line-Up Important Deadlines Your Audience Size of Audience Who will be in the audience? (clients, industry leaders, etc.) What is your speaker budget?