JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Request Dr. Lesley Francisco McClendon
Want Dr. LFM to speak at your event? Complete the form below.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
How did you hear about Dr. Lesley?
Your answer
Email
*
Your answer
Phone Number
Your answer
Event Name and Brief Description
*
Your answer
Event Website
Your answer
Event Location
Your answer
Date of Event
*
MM
/
DD
/
YYYY
Time
*
Time
:
AM
PM
What would you like Dr. LFM to do?
*
Keynote
Teach a class/workshop presenter
Guest Preacher
Guest Panelist
Other:
Is this event virtual, live or hybrid?
*
Virtual
Live
Virtual, but we'd like you to travel to be with us in person.
Hybrid (both virtual and in person)
Speech Title/Topic You'd Like Speaker to Address?
Your answer
How long does Dr. Lesley have to speak?
Your answer
Attire:
Your answer
Target Audience
Adults
Youth/Young Adult
Women
Men
Mixed Audience
Clear selection
Expected Attendance
Your answer
Speaker Budget Available
Your answer
Can Dr. Lesley bring product for sale?
Yes
No
N/A
Other:
Clear selection
Additional Information You Would Like the Speaker to Know.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
