Please fill out the form below to book Regina Robinson as a speaker for your next event.
Primary Contact Name *
Company/Organization/Group Leader *
Primary Contact Email *
Website Address *
Phone *
Source *
Social Media
Referral
Repeat Client
Other
Event Date *
Event Location *
Number of Attendees Expected *
Event Theme *
Purpose of Event (What do you want the participants to walk away with) *
Who is the Audience *
Professional Association
Corporate
College/University
Non-Profit
Faith Based Organization
Government Agency
Conference/Convention
In what capacity would you like Regina to participate *
What are you proposing to offer as a speaker fee *
Have you budgeted Travel & Lodging *
Promotion Plan *
TV
Radio
Flyer
Internet
Other
Comments, questions, or special notes *
Submit