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