Speaker Request Form Thank you very much for your request to have Rennie Curran speak at your upcoming engagement. Rennie considers it a huge honor that you would consider him. Please fill out the form below, submit the form, and a representative will contact you right away. We look forward to working with you!Name Title Email Phone Organization Type Elem/Middle/High SchoolCollege/UniversityNon-profitCorporateMediaEvent Name Venue Name Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryEvent Date Event Time 010203040506070809101112HH000510152025303540455055MMAMPMAM/PMExpected Audience Size and Demographic Please describe the audience (Gender, College Students, Athletes, Business Professionals, etc.)Describe the audience What are some of the challenges they face? What are the most important things you want them to learn or take away from this presentation?What type of presentation would you like Rennie to deliver? Powerful Keynote SpeechInteractive Professional Development WorkshopVirtual EngagementSchool AssemblyCommencement AddressPanel DiscussionInterview (Television,Radio, Podcast)OtherHow much time will Rennie have to speak? What is the purpose or theme for your event? Are there any specific topics you want Rennie to focus on? On a scale of 1-10, what must Rennie do to earn a 10 from you? Projected Budget for Securing Services? *Will Tickets Be Sold At This Event? YesNoCan products be sold at this event? YesNoWill you be filming or taking pictures at the event? YesNoHow did you find out about Rennie? Do you know of any other individuals, teams, or organizations that would be interested in booking Rennie? (Ask about our referral program) VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
