SPEAKING REQUEST

For virtual and live speaking requests, please submit all of the details of your conference or other event below. For press and podcast requests, please head to the Media Request page here.

Your Contact Info and Event Details

Contact Person

First Name

Last Name

Phone

Country

(###)

###

####

Organization

Please provide your organization's website URL and social media links.

Event Virtual Platform or Venue

Event Location [City / Province (State) / Country]

If your event is in-person, please include its location here.

Please indicate how many attendees are expected, as well as a brief overview of your expected audience [e.g., educators, your organization's staff, entrepreneurs, family caregivers (beginning/middle/end stage), musicians, etc.]

Please provide an estimate of your organization's budget for the speaker's honorarium.

Event Date

YYYY

Other Possible Event Dates

If there are other options for consideration, please include these here.

Time of Conference or Other Event

Please describe the capacity in which you're interested in working with Rosie at your conference or other event.

Select all that apply

Keynote Speaker

Q & A Panel

Interview

Other

Please provide any additional details we should know about your request.

SPEAKING REQUEST

Your Contact Info and Event Details

Looking forward to working with you! - Rosie

Rosie Paulyk