Empower Me: Presentation Request Form
Request an Empower Me presentation using this form. Your choices aren’t final—we will review everything together during our planning call.  
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Bring Empower Me to the Youth in your Community
Contact Information
Name of Organization/School *
Location of Event *
Name (Main Contact Person) *
Phone Number *
Email Address *
Topic Choice
Please choose the topic that aligns most closely with what your group needs right now. We’ll review it together in a follow-up call, and it can be adjusted at any time. Empower Me is committed to providing youth events that are responsive and adaptable.  
Topic Choice *
Presentation Format
Please select one or more formats. All choices can be modified later during our planning call.  
Presentation Format *
Required
Preferred Date #1 *
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Preferred Date #2 *
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Which language would you like the presentation delivered in? *
I understand that completing this form does not confirm a session. Melanie will be in touch soon to review details and finalize the booking.   *
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