Engagements & Sponsors Michael Brown Speakers Packet Engagements & Sponsors "*" indicates required fields I am interested inSpeaking EngagementsSponsorshipContact InformationName* First Last Email* Phone*Company Name* Company Website* Company's Primary Business* Event InformationDate of Event (Start) Month Day Year Date of Event (End) Month Day Year Time of Event (Start) Hours : Minutes AM PM AM/PM Time fo Event (End) Hours : Minutes AM PM 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 Website Event Name Event Location Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands 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? Yes No How Much?<$2,500$2,500-$5,000$5,000-$10,000$10,000-$20,000$20,000+Have You Heard Michael Speak Before? Yes No If so When? Where? Have You Hired Michael Before? Yes No If so When? Where? Have you reviewed Michael’s Speaker’s Packet? If not, would you like a copy e-mailed to you? Yes No Sponsorship 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* Month Day Year Sponsorship End Date* Month Day Year 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? Yes No How Much?<$2,500$2,500-$5,000$5,000-$10,000$10,000-$20,000$20,000+Have You Sponsored Michael Before? Yes No When and What Type of Sponsorship? Δ
