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Speaker Request Form

First and Last Name*

Email*

Company/Organization Name

Event Location (or virtual) *

Format of the Event (e.g., keynote, workshop, panel discussion, Q&A) *

Estimated audience size *

Target Audience (e.g., age group, profession, interests) *

Topic or Focus of the Presentation *

Duration of the Speaking Slot *

Is there a speaker fee or honorarium? If yes, what is the budget? *

Please Provide Any Additional Details *

Fitness coach for women

StrongHer Menopause

+1 (646) 247-5666

Thrive through Menopause

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