Form

Speaking Request Form

Thank you for your interest in working with Hina Khan. Please provide us with this information to better assist you.

First name*

Last name*

Email*

Phone number*

Company name

City

State/Region

Country/Region

Instagram

Facebook

Website URL

How did you hear about Hina Khan Worldwide Inc?*

Date of the Event (if unknown, please provide details of preferred dates)*

Type of Engagement (keynote, workshop, training session, emcee request, podcast guest, etc.)*

Audience Size*

Length of Presentation Time*

Speaking Topic / Details (What are your goals for the presentation?)*

What is your budget for this presentation?*

Virtual or In-Person? If live, please note Event Location (Including City, Province/State and Country). *

Additional Information