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Speaking Inquiry Form for Amy Killingsworth

Thank you in advance for taking the time to tell us about your event. 

Please complete the form below and our booking agent will get back to you shortly with next steps.

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Question 1 of 23

What type of speaking are you interested in?

A

Keynote

B

Keynote - multiple days

C

Mastermind - half day/evening

D

Mastermind - multiple days

E

Retreat Speaker

F

Participate as part of an Expert Panel

G

Interview Amy - Radio, Television, Podcast, Summit, Other (one time interview or a series)

Question 2 of 23

Name of your organization.

Question 3 of 23

Contact Person

Question 4 of 23

Website Address

Question 5 of 23

Industry, Profession or Religious/Non Profit Organization

Question 6 of 23

Address

Question 7 of 23

Email

Question 8 of 23

Phone Number

Question 9 of 23

Event Date

Question 10 of 23

Event Time

Question 11 of 23

Event Theme/Topic

Question 12 of 23

Event Title & Type

Question 13 of 23

Venue Name & Address

Question 14 of 23

Estimated Number of Attendees

Question 15 of 23

Please provide a link to your event’s website (alternatively please attach a draft agenda / program)

Question 16 of 23

 

Question 17 of 23

Self Empowerment

A

Inspirational

B

Motivational

C

Empowerment

D

Mindset Shift

Question 18 of 23

Wellness Based

A

General Health & Healing

B

Happier & Healthier Without Drugs

C

Eat to Thrive

D

Detoxification

Question 19 of 23

Emotional Intelligence & Health

A

Emotional Repatterning

B

Ending the Gender War

C

Radical Resposibility

D

Finding Meaning in Difficult Circumstances

Question 20 of 23

What do you want your audience to take away and really get out of this event? This helps me to customize my presentation for your event to meet your goals and objectives.

Question 21 of 23

What is the average income level of your attendees?

A

$50,000 - $75,000

B

$76,000 - $100.000

C

$101,000 - $150,000

D

$151,000 - $200,000

E

$201,000 - $250,000

F

$251,000 - $500,000

G

$501,000 +

Question 22 of 23

What is your budget for a  speaker (including accommodations)?

Question 23 of 23

Is there anything else you wish to share with us about your event that you think we should know?

Confirm and Submit