Request Dr. Simone as Keynote Speaker, Workshop Presenter, or Host for Your Next Event

Let's stop reaching for ordinary! It's time to transcend into the EXTRAordinary!


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Complete the form below to request this unique experience for your team, classroom, organization, colleagues, and friends and watch as your world flourishes with renewed purpose, harmony, and boundless joy.

We'll reply to you within 2-3 business days.

Thank you for choosing The Self Esteem Doctor. 🌷

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Email *
First Name *
Last Name *
Name of School, Organization or Event *
Phone Number *
Please provide a description of your organization and/or event. 
Include the purpose for requesting an appearance and any relevant event-links, if applicable.
*
Audience Demographics (click all that apply) *
Required
Approximate or Anticipated Group Size *
Which best describes your event needs? *
Is this event online or in person? *
What is the location of your event/organization?
Provide as much detail as you can at this time including country/parish/state/city/zip code for your event.

 If event is online, please indicate the platform.
 "zoom," "Streamyard," "EasyWebinar," etc... 

If location is unconfirmed, please indicate, "unknown"
*
Please indicate the desired Date for your event.  
Indicate month, day, and year if your event is already confirmed.  If not, please provide approximate month and year - or your preferred date options if flexible.
*
What is the duration the desired talk? (Dr. Simone's portion only) *
How did you hear about The Self Esteem Doctor?
(ie Instagram, Facebook, another event, newsletter, friend)

If you were referred to us by a friend, family member, professional, booking agent or affiliate, please list their first and last name because we definitely want to thank you them!
*
A copy of your responses will be emailed to the address you provided.
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