Speaking Request Form

Thank you for your interest in booking Janice to speak at one of your events. Please complete the form below, and we will be in touch shortly to discuss your needs.

Client Information

First Name

Last Name

Phone

Company/Organization

Title / Position

What type of speaking event are you interested in hiring Janice for?

Opening Keynote

Closing Keynote

Expert Panel

Presentation/Workshop

On Stage Interview

Podcast

Other

Not Sure Yet

How did you hear about Janice Otremba?

What topic(s) are you interested in having Janice speak on?

Is this event going to be recorded?

Yes

Not Sure Yet

Event Information

Event

Event Location or Hosting Platform (If known)

Event Date (If known)

Event Website URL (If live)

Proposed Budget (If known)

Approximate number of attendees (If known)

Is there anything else you would like to share with Janice about your event?

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have a quick question?

First Name

Last Name

Phone

How can I help?

I acknowledge that myself and my team live and work within the Tk'emlups te Secwépemc territory, situated within the unceded ancestral lands of the Secwépemc Nation.