Speaking Request form Name * First Name Last Name Email * Phone Number * Country (###) ### #### Orgainisation Name/ Company Name * Event Title * Event Website Event Location? * Speaking Date Requested? * MM DD YYYY Time of the Event? * Hour Minute Second AM PM What is your budget? * Booking Rodina for: * Keynote (40-60mins) Panel member Podcast Guest/Host Corporate Workshop/Seminar University Workshop/Seminar School Workshop/Seminar Conference Online Webinar Q&A Other Number of Talk(s) * Length of Talk? * Topic? * Number of Attendees? * Audience (e.g. Teenagers, Women 30+, Men 40+ etc) * How did you hear about me? * Social Media Website Word of mouth Other Message * Thank you for completing the form! We will be in touch with you within 48 business hours. Interested in working together? Please complete the form below and we will be in touch shortly!