Speaking Request form Interested in working together? Please complete the form below and we will be in touch shortly! Name * First Name Last Name Email * Phone Number * Country (###) ### #### Orgainisation Name/ Company Name * Speaking Date Requested? MM DD YYYY Booking Rodina for: * Keynote Speaker (40-60mins) Panel member Podcast Guest Online Webinar Corporate Workshop/Webinar University Workshop/Webinar School Workshop/Seminar Conference Speaker Q&A Other Message * How did you hear about me? * Social Media Website Word of mouth Other Thank you for completing the form! We will be in touch with you within 48 business hours.