Speaker Request Form
Thank you for inviting Lead My Heart (LMH) and Dr. Wanita Mercer to be a part of your special event! To ensure that we are a good fit for your event and that we are able to achieve your desired outcomes, please complete this form. After reviewing, a team member will contact you to ask clarifying questions, send you a quote, or provide next steps via E-mail. 

God bless you!

Questions? Text or leave a voicemail at (210) 504-8070 or email contact@leadmyheart.com.
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Email *
Requestor's First and Last Name *
Phone Number *
Name of Event *
Date of Event (If unsure, proceed to next question.)
MM
/
DD
/
YYYY
What day of the week are you planning to host your event? *
Required
Name of Organization Hosting Event *
Organization Type *
Organization Website or Social Media Link
Event Location/Address *
Presentation Length *
Presentation Start Time *
Time
:
Requested Presentation Topic(s) *
Required
What is your preferred presentation or consultation lens? *
Requested Presentation Type *
Requested Presentation Title
What's your preferred mode of presentation? *
How did you hear about me? *
Audience Composition (career professionals, entrepreneurs, college students, mostly women, etc.)
Number of Attendees Expected
Average Age of Audience
What goals or objectives do you want the presentation to address?
 *
How do you want the audience to feel after the presentation? (ex. inspired, informed, educated , empowered, etc.)
Non-Profits: What is the amount of your speaker honorarium/rate?
Additional Comments (Is there anything else you'd like us to know before preparing your proposal?)
Acknowledgement: 
I understand that by submitting this form I am only requesting to be contacted about this booking request and that the booking has NOT yet been confirmed.
 *
A copy of your responses will be emailed to the address you provided.
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