Speaker Request Form
Thank you so much for your interest in having Melissa Ifill, LCSW speak at your event. Please complete ALL questions below.
Email *
Date of Event *
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Location of event *
Theme/Purpose of event *
What is the intended mood/vibe of event? *
How many people do you anticipate? *
Please describe your intended vision for my participation in this event. *
Are you selling tickets to you event? If so, what is the price per person? *
Do you have any sponsors? *
What is your budget for speakers? Does it include travel, lodging and food? *
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