Speaking

Name *

First Name

Last Name

Phone *

(###)

###

####

What services are you interested in? *

Speaking Engagement

Podcast / Media Interview

International

Which format(s) are you interested in? *

Keynote / Main Talk

Guided Workshop or Small Group

Panel

Other

Event Date *

MM

DD

YYYY

Event Location (City + State) *

(Please note: travel & lodging costs are required for out-of-state bookings.)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Time of Event *

Hour

Minute

Second

AM PM

Will you be covering travel and lodging (if applicable)?

Yes

No

Not applicable (virtual)

Let's Discuss

How did you hear about Termeil or The Golden Discovery? *

Podcast

Social Media

Referral

Past Event

Other