Speaking Engagements Request

Niurka Inc. is your solution for a dynamic and powerful presentation. Please invest a moment and respond to the questionnaire below.  Once we receive your inquiry, we will customize a proposal based on your specific needs and email it to you in just 48 hours!

Please indicate the type of event for which you need a speaker.		Conference Convention Company-wide Meeting Awards Ceremony Sales Event Banquet Leadership Forum Training Seminar Corporate Pep Rally Marketing Event Other If other, please be specific:
Please tell us who specifically will be attending your event. (please check all that apply)		All Team Members Leadership / Executive Team Management Team Sales Force Customer Service HR / Legal Customers Vendors General Public Professors / Faculty Students / Alumni Youth / Teenagers Other If other, please be specific:
How many people (approximately) will be in attendance?
What is the scheduled date of your event?		(dd/mm/yyyy)
Please indicate the desired duration of the speaking session.		- Select - Keynote (up to 1.5 hours) Half Day (up to 4 hours) Full Day (up to 8 hours) Multi-Day
Where specifically will your event be located?
Country		USA UK Albania Algeria American Samoa Andorra Angola Anguilla Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Barbuda Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Botswana Brazil British Virgin isl. Brunei Bulgaria Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Rep. Chad Channel Islands Chile China Colombia Congo Cook Islands Costa Rica Croatia Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Irak Iran Ireland Ireland, Northern Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kuwait Kyrgyzstan Latvia Lebanon Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar/Burma Namibia Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Rwanda Saba Saipan Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovak Republic Slovenia South Africa South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tanzania Thailand Togo Trinidad-Tobago Tunisia Turkey Turkmenistan United Arab Emirates U.S. Virgin Islands U.S.A. Uganda United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wales Yemen Zaire Zambia Zimbabwe
State		-Select One- AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WI WY
City
What specifically is most important to you when hiring a speaker?
What industry are you in?		- Select - Agriculture Architecture & Engineering Automotive & Transport Banking Computer Hardware Computer Software Distribution Education Environmental Fashion & Beauty Financial Services Food Services Government Health & Wellness Hospitality Information Technology Insurance Legal Services Manufacturing Marketing & Advertising Media & Entertainment Mortgage Network Marketing Non-Profit Real Estate Retail Sales Social Services Sports Staffing & Recruiting Telecommunications Training & Development Transportation Wholesale Sales
What topics are you interested in?		Purposeful Leadership Laws of Supreme Influence Sales Mastery World Class Service Standards of Excellence Dynamic Communication State of Mind Recipe Building High Performance Teams
What is your budget for hiring a speaker?		- Select - Less than $5,000 Up to $8,000 Up to $10,000 Up to $15,000 Up to $20,000 Up to $30,000 Up to $50,000

Please provide us with your name and contact information. We will contact you with any questions, if needed, prior to emailing your proposal.

Name	*
Title or Position
Company Name
Company Address
City
State
Zip
Country		USA UK Albania Algeria American Samoa Andorra Angola Anguilla Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Barbuda Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Botswana Brazil British Virgin isl. Brunei Bulgaria Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Rep. Chad Channel Islands Chile China Colombia Congo Cook Islands Costa Rica Croatia Curacao Cyprus Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Ethiopia Faeroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Irak Iran Ireland Ireland, Northern Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kuwait Kyrgyzstan Latvia Lebanon Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar/Burma Namibia Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Rwanda Saba Saipan Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovak Republic Slovenia South Africa South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tanzania Thailand Togo Trinidad-Tobago Tunisia Turkey Turkmenistan United Arab Emirates U.S. Virgin Islands U.S.A. Uganda United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wales Yemen Zaire Zambia Zimbabwe
Phone	*
Alternative Phone
Email	*
Website
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