Speaking Request Form

Thank you for your interest in booking me to speak at one of your events. Please complete the form below, and my assistant will be in touch within (2) business days to schedule an exploratory call.

Client Information

First Name

Last Name

Email

Phone

Company/Organization

Title / Position

What type of engagement are you looking for? (Check all that apply)

Opening Keynote

Closing Keynote

Plenary Session

Breakout Session

Expert Panel

Presentation/Workshop

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

No

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?

Learn strategies for organizational change to drive business growth, development, and success from a top leadership coach, and People & Performance Catalyst.

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have a quick question?

First Name

Last Name

Email

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.

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