Any Other Details Pertinent to this Request*

Name of Organization (include website if available)*

Address*

Name of Primary Contact Person*

Email of the Primary Contact Person*

Event Date*

What Time Would Oghosa Speak?*

Type of Event (i.e. Conference, Retreat, Seminar)*

Theme of Event*

Time Allotted for Oghosa’s Presentation*

Anticipated number of attendees for this event*

Demographic and Profile of Group(s) to be spoken to*

What exactly would you like Oghosa to do (i.e. - interview/panel, conference workshop, keynote)? Is there more than one appearance requested?*

Is this event virtual or in person?*

Please specify an amount versus leaving an open-ended comment/question.

Is travel/lodging included for the speaker ? What is the closest airport? Will ground transportation and meals be provided? (Oghosa travels from Dallas) *

Budgeted Honorarium*