Ian Michael Brock Booking Request

Ian Michael Brock

Booking Request Form

Please complete the form below and include your budget.

All budgets will be reviewed and considered (including pro bono speaking requests), but you MUST submit a budget.

Event Name

Organization's Name

For Profit / Not for Profit:

Please select

Event Description - please provide a description of your event. Please also tell us the mission/purpose and goal of event

Event Date

If there are multiple date options, please include in "Additional Information" section

YYYY

Time of Event (please convert to Chicago-Central Time). Use link below

Convert Your Time Zone Here: https://www.timeanddate.com/worldclock/converter.html

Hour

Minute

Second

Organization's Website

http://

Event Website

Please list URL if there is one

http://

Length of Requested Speaking Time

Speaker's Requested Role

Topic - What would you like Ian to discuss/present?

Event Location

If not in person, please list as VIRTUAL

Event Attendee Demographics

Please list who Speaker will be addressing (please be as specific as possible - i.e., Gen Z, Millenials, Parents, Educators, Executives, etc,)

Estimated Attendee Size

Will this be a LIVE session? Or will it be RECORDED so that it's played later for your event?

Event Contact's Name

First Name

Last Name

Event Contact's Email

Event Contact's Mobile #

(###)

###

####

Speaking Budget

Please include the budget for your event. As stated above, all budgets will be reviewed and considered. Ian's standard fees (excluding travel expenses) are as follows: - $7,500 for virtual / pre-recorded - $10,000 for in-person

How did you hear about us?

Additional Information

Please list addition details of the event here, including the TOPIC you'd like Ian to speak about during Your Event.

If you would like to return to Ian’s EPK click here.