Eric The Counselor Speaker & Public Engagement Request Form
Email address *
First and Last Name *
Organization *
Phone number *
Category *
If a conference, is it regional, national or international
Name of your event? *
Event description *
What is your budget for the speaker? *
Date of your event *
Location *
Who will make up your audience? *
What is the size of your audience? *
What perspective would Eric The Counselor add to your event? Are there topics or areas of particular interest you’re interested in hearing about from Eric? * *
Will the media be in attendance *
Please list other confirmed participants in your event we might want to know about
Please add any additional information that might help us!
A copy of your responses will be emailed to the address you provided.
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