Cory Chapman Speaking Request

Thank you for your interest in having Corychapman speak at your event!
Please complete the following survey and we'll respond to your request as soon as possible.
Thank you!

1. Please provide your contact information:

2. Website:

3. Please provide the name, date and location of the event. (MUST be at least 6 months out)

4. Please describe the event:

5. Please provide the length of time you would like Corychapman to speak:

6. What would you like attendees to take away from this event?

7. Please describe your audience demographic (i.e. age, geographic region, psychographic profile, etc):

8. What is you speaking budget range?

9. Is this the first time you are hosting this event?

10. If no, how many attendees did you have at the last event?

11. How many attendees are projected to come?

12. Please describe your marketing plan to fill the event: