Name of Contact Person/Decision Maker.

If this is NOT you then share this form link with that person or please make sure they are aware that someone from Gary's team will be reaching out and so that they are familiar with his work and have interest.

Full Name *

Phone number for contact listed above, preferable a number that can accept a SMS *

Email *

Approximate Number of attendees *

Date(s) you're looking to have Gary speak to your group *

Who is your audience typically made of? (sales, marketing, C-execs, entrepreneurs, etc) *

Who have some of your previous speakers been? *

How many day(s) is your event? *

Roughly what is your budget for your keynote speaker for this event? *

Please enter company's website & social media handle (Instagram, Facebook, Youtube, etc) *

How did you hear about Gary? *

I spoke with Gary or his team directly

Social Media Post

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Other

Is there anything you might care to add that you feel would be important for us to know before contacting you? *

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