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Request Dr. Simone as Keynote Speaker, Workshop Presenter or Host for Your Next Event
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Email
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Your email
First Name
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Your answer
Last Name
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Your answer
Name of School, Organization or Event
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Your answer
Phone Number
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Your answer
Please provide a description of your organization and/or event, including the purpose for requesting an appearance, date(s), time(s) and relevant event-links if applicable.
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Your answer
Audience Demographics (click all that apply)
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Kids (elementary school)
Tweens (middle school)
Teens (high school)
Adults (professionals or corporate event)
Adults (parents)
Adults (women/moms only or men/dads only)
Youth Models
Adult Models
Other:
Required
Approximate or Anticipated Group Size
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0-30
31-50
51-99
100-199
200-299
300+
Other:
Which best describes your event needs?
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Keynote/Guest Speaking Appearance
Hands-on Workshop
I'm not sure
Runway Confidence Coaching (General)
Runway Coaching Event for Models
Seasonal Request: i.e. "Self-Esteem Santa," etc..
Other:
Is this event online or in person?
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Online
In-person
Other:
What is the full address or country/parish/state/city/zip code for your event? (provide as much detail as possible) If event is online, please indicate the platform "zoom," "Streamyard," "EasyWebinar," etc...
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Your answer
Please indicate the desired month and year - or the specific date if you have it - for your event.
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Your answer
What is the duration the desired talk? (Dr. Simone's portion only)
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30 minutes to 1 hour
Over an hour
Over 2 hours
Multi-day talk
Other:
A copy of your responses will be emailed to the address you provided.
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