If you would like to schedule Nathan Fluellen as a speaker at your next conference or event, please fill out the form below or call 615-566-2107

Name
First and Last Name
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Primary Contact's Email Address
Email
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Primary Contact's Phone Number
Phone
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Primary Contact's Mobile Phone
Phone
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Secondary Contact's Name
First and Last
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Secondary Contact's Email
Email Address
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Secondary Contact's Phone Number
Phone Number
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Name of Organization
Name
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Organization Website
URL
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Organization Type
Type
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Organization Industry
Which Industry?
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Additional Organization Details
Details
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Additional Organization Details
Details
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Role in event
What Role Would You Like Us To Full
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Role in event
What Role Would You Like Us To Full
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Prospective Date of Event -- First Choice Date
Select a date
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Second Choice Date
Select a date
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Keynote Topic
Please Describe Topic Here.
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Event Start Time
Time
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Start Time of Speaker
Time
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End Time of Speaker
Time
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Event Name
Name of Event
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Event Description
Tell us about the event
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Event Description
Tell us about the event
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Panel Topic
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Panelists: Specific Names and Affiliation
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Venue Name
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Your Address
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Closest Airport To Venue
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Audience
Please provide a description (i.e. size, ceo, employees, etc)
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What media outlets (radio, television, newspaper) will be present at this event?
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How is the event being promoted?
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Organization Will Cover Expenses
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Expenses Covered By Organization
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Honorarium
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What is your budget for a speaker?
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Deadline for Response
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