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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.
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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.
Include the purpose for requesting an appearance and any relevant event-links, if applicable.
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Your answer
Audience Demographics (click all that apply)
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Adults (gala, conference, or other non-corporate gathering)
Adults (professionals/corporate events)
High-performing Teens & young adults (high school, clubs, honor societies, Greek-life)
Specialty Group (Celebrities, models, professional athletes, high-profile, influencers, etc)
Other:
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Approximate or Anticipated Group Size
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0-30
31-50
51-99
100-199
200-299
300+
500+
1,000+
5,000+
10,000+
Other:
Which best describes your event needs?
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Keynote Address: Using Inner Power to Fuel Outer Impact
The Signature 10-Tip Talk: 10 Self-Help Tools You Never Knew Existed (And Why They Actually Work)
Neuroscience of Confidence & Physiology (Body-Confidence Workshop with Runway/Modeling Theme)
The 6-Point Total Wellness Framework for High Achieving Professionals (Corporate Training)
Author Visit: Book Signing + Presentation or Workshop + Coaching Lounge
Custom Guest Speaking Appearance
I'm not sure
Other:
Is this event online or in person?
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Online
In-person
Hybrid
Other:
What is the location of your event/organization?
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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"
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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.
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What is the duration the desired talk? (Dr. Simone's portion only)
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30 minutes to 1 hour
1 to 2 hours
2 to 4 hours
4 to 6 hours
Full Day Training (8-hrs)
Multi-day talk
Other:
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 w
e definitely want to thank you them!
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