Request Dr. Simone as Keynote Speaker, Workshop Presenter or Host for Your Next Event
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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, including the purpose for requesting an appearance, date(s), time(s) and relevant event-links if applicable. *
Audience Demographics (click all that apply) *
Approximate or Anticipated Group Size *
Which best describes your event needs? *
Is this event online or in person? *
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... *
Please indicate the desired month and year - or the specific date if you have it - for your event. *
What is the duration the desired talk? (Dr. Simone's portion only) *
A copy of your responses will be emailed to the address you provided.
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