Keynotes & Engagements Form

Name:

Organization/Institution

Email:

Phone:

Website/Social Media

Event Name

Event Date

Event Type

Event Location

Expected Audience Size

Audience Type

New Field:

Desired Length of Engagement

Honorarium/Budget

Would you like to request consideration for reduced pricing or sponsorship partnership?

Yes

Who will cover travel and accommodations?

A/V Setup Available

Recording or Streaming Planned?

How did you hear about Dr. Johnson?

Anything else we should know about your event or audience?

File/Flyer Upload

Upload File

By submitting this form, I understand this is an inquiry only and does not confirm a booking. A member of The Pink Kingdom team will contact me to discuss details and availability.

Yes

Keynote & Engagement Submission Form