Engagements & Sponsors Michael Brown Speakers Packet Engagements & Sponsors I am interested inSpeaking EngagementsSponsorshipContact InformationName* First Last Email* Phone*Company Name*Company Website*Company's Primary Business*Event InformationDate of Event (Start) MM DD YYYY Time of Event (Start) : HH MM AM PM Date of Event (End) MM DD YYYY Time fo Event (End) : HH MM AM PM Type of Event* In Person Video Conference Phone Conference Hosting Organization (If Different From Contact Information)Hosting Contact Information (If Different From Contact Information) First Last Hosting Contact Email Hosting Contact PhoneHosting Contact WebsiteEvent NameEvent Location Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Event Size 0-100 100-250 250-500 500-1,000 1,000+ Nature of Speaking Engagement (check all that apply) Keynote Panel Discussion Panel Host Training Other Which Date(s) of the Event would you like Michael to Speak?Do You Have A Budget?YesNoHow Much?<$2,500$2,500-$5,000$5,000-$10,000$10,000-$20,000$20,000+Have You Heard Michael Speak Before?YesNoIf so When? Where?Have You Hired Michael Before?YesNoIf so When? Where?Have you reviewed Michael’s Speaker’s Packet? If not, would you like a copy e-mailed to you?YesNoSponsorship InformationDo you have a sponsorship package in mind?No (if No, we will have a Representative contact you to discuss options)Yes (if Yes, please fill out the information below and we will contact you)Sponsorship Start Date* MM DD YYYY Sponsorship End Date* MM DD YYYY Type of Sponsorship (Check All Boxes That Appy) Website Banner Ads Podcast Ads Position Pre-Roll Podcast Ads Position Mid-Roll Podcast Ads Position Post-Roll Podcast Ad Duration 15 sec Podcast Ad Duration 30 sec Podcast Ad Duration 60 sec Videocast Ads Position Pre-Roll Videocast Ads Position Mid-Roll Videocast Ads Position Post-Roll Videocast Ad Duration 15 sec Videocast Ad Duration 30 sec Videocast Ad Duration 60 sec Embedded Blog Ads Embedded Newsletter Ads Partner Broadcast Ads (may be subject to Partner terms and conditions) Do You Have A Budget?YesNoHow Much?<$2,500$2,500-$5,000$5,000-$10,000$10,000-$20,000$20,000+Have You Sponsored Michael Before? YesNoWhen and What Type of Sponsorship?
