Book A Meeting with Nikki Clarke

First and Last Name *

Organization / Company Name

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Event Details

Event Name

Event Description

Please describe your event, including the theme, purpose, and expected outcomes.

Event Date

Event Time

End Time

Event Location

In-Person

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If in-person, please provide the city, province/state, and venue name.

Estimated Number of Attendees

Role & Services Requested

Requested Role for Dr. Nikki Clarke

Keynote Speaker

Master of Ceremonies (MC)

Panelist

Workshop / Facilitator

Live Performance (Music / Spoken Word)

Combination (please specify below)

Checkbox all that apply

If combination selected, please describe

Audience & Objectives

Target Audience

e.g. entrepreneurs, youth, women leaders, corporate teams, educators, community members

Desired Takeaways

What key message or impact would you like Dr. Nikki Clarke to deliver?

Budget & Logistics

Budget Range for This Engagement Budget Range for This Engagement

Does your budget include travel and accommodation (if required)?

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No

Not applicable (virtual event)

Additional Information

Additional Expectations or Requests

Media appearance

Book signing

Meet & greet

Social media promotion

Branding mention

Other (please specify)Other (please specify)

Any Additional Notes or Information

Agreement & Submission

Acknowledgement

I understand this form is a booking request and does not confirm participation until a contract and payment terms are agreed upon.

Book Dr. Nikki Clarke