Speaking Engagement Request (Virtual Only)
Upon completion of this form, I will contact you within 2-3 business days to go over further details and availability. I look forward to the possibility of collaborating with you.
* Required
Email address
*
Your email
What is the name of your organization?
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Your answer
What is the name of your event?
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Your answer
What is the topic or main focus of the presentation you are seeking?
Your answer
Who is the audience of your event? (Community members, professionals, therapists)
*
Your answer
What is the length of time of the presentation you are requesting?
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Your answer
What is the date of your event?
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Your answer
Your name
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Your answer
Phone number
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Your answer
Preferred contact method
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Phone
Email
Other:
Required
How did you hear about me?
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Your answer
Any other details you think are important to know?
Your answer
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