Shake Up Learning: Speaking Request Form

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Professional Development/Speaking Request/Virtual Training

Thank you for your interest in Shake Up Learning speaking services. Please complete the form below.

We will contact you about this request as soon as possible.

District/Organization *

Name *

Title *

Email Address *

Phone Number *

How did you hear about Kasey Bell or Shake Up Learning? *

Who are you requesting to speak? *

Kasey Bell (only)

Kasey or other Shake Up Learning trainers that are available to meet our needs.

Pam Hubler

Susan Vincentz

Jen Giffen

Tammy Lind

Sarah McKinney

Sarach Kiefer

Carolina Ramirez

Virtual or In-Person? *

IN-PERSON: We are looking for a speaker or trainer for an in-person event.

VIRTUAL: We are looking for a speaker or trainer to deliver a virtual session.

Type of Service * *

Please choose the type of service that will help meet your needs. (check all that apply)

Custom PD/Workshop

Conference Presentation(s)/Breakout Sessions

Keynote

Book Signing

Other:

Required

Name of Event *

Event Hashtag

Topic(s) Requested/Details of What You Need for Your Event *

Please be specific on what topics you would like covered. Please let us know if this is a multi-day event.

Date of Event (first choice) *

YYYY

Date of Event (second choice)

YYYY

Where? Location of the event. *

Please include the physical address if available.

Nearest Airport *

Capacity *

Please indicate the capacity of the location. Hands-on workshops are usually limited to between 12 and 30 participants, with 20-25 being ideal. Keynotes and breakout sessions may of course include a higher number of participants.

Equipment Available *

Please indicate the operating system, software, peripherals, and Internet connection(s) available at the location. Include other technical details as necessary.

Technical Support *

Please indicate who will be responsible for technical support at the location. Provide contact information if possible.

Event Coordinator/Logistical Support *

Please indicate who will be responsible for logistical support (such as registration) at the location. Provide contact information if possible.

Audience *

Please indicate if the topic should be focused for a particular audience, such as administrators or teachers of a specific grade or subject.

Audience Level *

Beginner

Intermediate

Advanced

Trainers (for Train the Trainer events)

Expected number of participants *

Details of Your Needs/Goals *

Please provide a list of goals for this workshop, including the level of participants. For instance, first year implementing G Suite and/or chromebooks, etc.

Would you like to purchase books for your participants at a discounted price? *

Blended Learning with Google: Your Guide to Dynamic Teaching and Learning

Google from A To Z: The Google Glossary for Teachers

Shake Up Learning: Practical Ideas to Move Learning from Static to Dynamic

Maybe, I would like to learn more

No thanks

Required

Billing Address *

Proposal Approval *

Please indicate the name, title, address, email, and phone number of the person for whom the proposal should be prepared if you will not be signing the proposal.

Would you like to receive emails about resources for school? *

Yes

Submit Your Request

The cost of events varies and will depend on the options chosen below. We will provide you with a customized proposal and quote based on the options you selected.

NOTE: You must click submit below for your answers to be recorded.

You may contact Kasey directly with further questions here: Kasey@ShakeUpLearning.com.

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