Name

Email Address

Organization

Role

What needs does your organization have that have led you to consider bringing Winston in as a Speaker?

What is your intended outcome for your organization after bringing in an expert, such as Winston?

Date of event? Estimates are fine.

What type of event are you planning? What type of event are you planning? In-person Virtual Hybrid Other

What is your budget range for this engagement? What is your budget range for this engagement? Less than $3,000 $3,000 – $5,000 $5,000 – $10,000 $10,000 – $20,000 $20,000+

Anything else we should know?