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Speaker Inquiry Form
Name
Last Name
Company/Organization
Job Title/Role
Email
Phone Number
How did you find Nicole or MavenHeart?
Select one
Apple - Podcast "Weight Loss for Women Over 40"
Spotify - Podcast "Weight Loss for Women Over 40"
Audible - Podcast "Weight Loss for Women Over 40"
iHeart - Podcast "Weight Loss for Women Over 40"
Other Podcast Platform
Another podcast (Nicole was a guest)
This Is It TV Network
Facebook
Facebook AD
Instagram
LinkedIn
YouTube
TikTok
Networking Event
Referral
Other
Event Name
Select one
Conference
Corporate Event
Retreat
Summit
Workshop
Podcast
Panel
Private Event
Other
Event Date and Location (City, State, Country or Virtual)
Is this event in-person or virtual?
In-person
Virtual
Hybrid
Expected Audience Size
Under 50
50β100
100β250
250β500
500β1,000
1,000+
What type of opportunity are you interested in?
Keynote
Breakout Session
Workshop
Panel Discussion
Podcast Interview
Retreat Session
Fireside Chat
Which keynote interests you most?
#1 Stop Leaving Yourself Behind
#2 Why Change Doesn't Stick
#3 The Relationship You're Missing
Tell us about your audience (Who will Nicole be speaking to, and what challenges or goals are most relevant to them?)
What is your speaking budget?
Under $2,500
$2,500β$5,000
$5,000β$10,000
$10,000+
Is travel required?
Yes
No
Possibly
Anything else you'd like Nicole to know?
I understand completing this form is an inquiry and does not guarantee booking.
Submit to Request Nicole
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