Speaking Request Form

Thank you for your interest in having Erin M. Jacobson, Esq. speak at your event. Please complete and submit the form below to send your request to Ms. Jacobson.

Contact Information

Your Name *
Your Organization *
Your E-mail Address *
Your Telephone Number *
Organization Website *

Event Information

Date of Proposed Event *
Start Time of Proposed Event *HHMMAM/PM
End Time of Proposed Event *HHMMAM/PM
Name of Proposed Event *
Preferred Topic(s) *
Preferred Format of Ms. Jacobson's Participation *
Panel MemberKeynote Solo Speech
Amount of Time Required for Event *
Name of Event Venue *
Address of Event Venue *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Estimated Number of Attendees *

Event Promotion and Fees

Event Promotion *
Please provide a brief description as to how the event will be promoted and to whom.
Please check all that apply. *
This is a private event (not open to the public).This event is open to the public.Admission to this event is free.There is a fee charged to attend this event.
Please list the admission fee amount. *
Speaker Fee Amount *Please indicate the fee offered for Ms. Jacobson's appearance.
Please check all that apply. *
We will cover or reimburse Ms. Jacobson's parking and other admission fees.We will reimburse travel expenses and mileage.We will reimburse mileage only.
Thank you for your request. Thank you for submitting a request to have Ms. Jacobson speak at your event. We will respond to your inquiry as soon as possible.

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Speaking Request Form

Contact Information

Event Information

Event Promotion and Fees

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