Request edit access
Heather Durenberger Speaker Request Form
Thank you for your interest in booking Heather for your event. The information on this form helps with the booking and reservation process. Let us know if you have any questions at durenbergerh@gmail.com. We look forward to working with you and your group!
Email address *
Heather Durenberger, consultative coach, instructor, public speaker, and author.
Name of Your Organization *
Your answer
Please describe your mission and purpose *
Your answer
Website
Your answer
Your Name *
Your answer
Your Phone Number *
Your answer
Are you the decision maker for this event, or are you acting on behalf of others? *
Mailing Address (Street, City, State Zip) *
Your answer
Possible dates for your event *
Your answer
Possible location of your event
Your answer
Type of Event *
Type of Leading by Heather *
Describe the number of sessions and length you are requesting and time(s) they will take place. For example a 1/2 day retreat 9-12 noon, an overnight retreat Friday 7-9 pm + Saturday 9-1 pm or keynote address for 60 minutes *
Your answer
Desired Topics *
How Many Do You Plan on Attending? *
Your answer
Heather likes to have her books available for purchase. Would you like to have them shipped to your location? *
How do you plan to promote this event? *
Your answer
Is there anything you would like Heather to know about your organization, or audience in planning this event?
Your answer
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service