Ian Michael Brock Booking Request Ian Michael BrockBooking Request FormPlease complete the form below and include your budget. All budgets will be reviewed and considered (including pro bono speaking requests), but you MUST submit a budget. Event Name * Organization's Name * For Profit / Not for Profit: * Please select For Profit Not for Profit Event Description - please provide a description of your event. Please also tell us the mission/purpose and goal of event * Event Date * If there are multiple date options, please include in "Additional Information" section MM DD YYYY Time of Event (please convert to Chicago-Central Time). Use link below * Convert Your Time Zone Here: https://www.timeanddate.com/worldclock/converter.html Hour Minute Second AM PM Organization's Website * http:// Event Website Please list URL if there is one http:// Length of Requested Speaking Time * 30 Minutes 45 Minutes 1 Hour Half Day All Day Other - Please list in "Additional Information" Speaker's Requested Role * Keynote Address Host Panelist Fireside Chat Moderator Interview Podcast Guest Mentoring Session Other Topic - What would you like Ian to discuss/present? * Event Location * If not in person, please list as VIRTUAL Event Attendee Demographics * Please list who Speaker will be addressing (please be as specific as possible - i.e., Gen Z, Millenials, Parents, Educators, Executives, etc,) Estimated Attendee Size * Under 500 500 - 1,000 1,000 - 3,000 3,000 - 5,000 5,000+ Will this be a LIVE session? Or will it be RECORDED so that it's played later for your event? * Live Recorded Event Contact's Name * First Name Last Name Event Contact's Email * Event Contact's Mobile # * (###) ### #### Speaking Budget * Please include the budget for your event. As stated above, all budgets will be reviewed and considered. Ian's standard fees (excluding travel expenses) are as follows: - $7,500 for virtual / pre-recorded - $10,000 for in-person $ How did you hear about us? * Word of Mouth Social Media LinkedIn Search Engines (Google, Bing, etc.) Events - Heard you speak Other Additional Information Please list addition details of the event here, including the TOPIC you'd like Ian to speak about during Your Event. Thank you! We will review your Speaker Request and one of our team members will contact you regarding Ian’s availability for your event.Have an awesome day :) If you would like to return to Ian’s EPK click here.
