Your name:

Organization name:

Email address:

Your business or organization's website link:

Phone:

Event date:

Event location & time: (if virtual, please note the platform)

How long would you like Trip to speak?

Topic of speech/keynote:

Describe your event & audience: (expected audience size, expected outcome of the event, any other speakers presenting, and how the event will be marketed)

What is the speaker fee?

Please check one: Please check one: I have the financial resources to engage you I'm currently raising funds for this project