SPEAKER REQUEST FORM

If you or your organization would like to request Janine Hernandez for a speaking engagement or book signing, please complete this questionnaire.

Full Name

Email *

Phone *

Organization *

City *

Will this be recorded? *

Is this a ticketed event? *

Number of attendees expected? *

Event Website *

What is the audience profile? *

Topic of interest you would like Janine Hernandez to speak to? *

How long will you need Janine Hernandez to speak? *

What are you proposing to offer Janine Hernandez as an Honorarium/Speaker Fee? *

What expenses have you budgeted for Janine Hernandez's travel, transportation, and overnight accomodations? *

How do you plan to market and advertise your event? *

Any additional notes about the event you would like us to know?