Registration for Speaking Event

Event Title*

Event Date*

Event Time*

Location / Venue of the event*

Country of the event*

Mission Statement / Purpose of your Organization

Objective of the Event

Website for your Event / Organization* (e.g. https://Israel120.com) Please include “https://” or “http://” in your website URL.

Will the event be open to the public?

Estimated number of Attendees

Will this be a ticketed event?

Average price of the tickets (if ticketed)

How do you plan to market and advertise your Event?

Demographics of Attendees

Name of other speakers speaking at the event

Name of Company to be listed on the contract

Address of Company to be listed on the contract

Name & Title of who will be signing contract from Company

Name

Address

Cell Phone

Where did you first hear about us?