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Event/Speaking Request

Complete the following form to request Doug for your event. A request should be completed at least two weeks prior to the event date and is subject to availability. You should receive a response from the team within 48 hours of submission. Typical fee structure can be found here.

Contact Name *

First Name

Last Name

Email *

Phone *

Country

(###)

###

####

Company/Group *

Event/Group Type(s) *

Select all that apply.

Student Group

Company

Non-Profit Organization

Political Organization

Community Event

Tax Exempt

Group/Event Website

http://

Request Type(s) *

Select all that apply.

Speech

Meet and Greet

Question and Answer

Panel Discussion

Other

Presence

Virtual

In-Person

Either

Preferred Date(s) *

Event Time/Duration *

Number of Expected Attendees *

Event Address (if applicable)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Message *

Thank you!

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