Speaker Request Form

Speaker Request Questionnaire

Presentations that Educate, Inspire, and Motivate...
Using lively presentations Dr. Bridget ties in her professional experience and education together to provide her audience with valuable components that encompass her vision of healing, inspiration, motivation, and success.
Name *

First Name Last Name
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Date of Event *

Year Month Day
Date
Name of Conference or Event *
Expected Number of Attendees
Event Type *

Summit Conference Business Church Service/Prayer Breakfast Book Signing Health & Wellness/Medial
What's Your Speaker Budget? *
What type of talk would you like Dr. Bridget to cover? *

Host/Facilitate Breakout Session Keynote Trainer Panelist
Have you worked with Dr. Bridget in the past? If so, when?
Are there any sensitive issues that Dr. Bridget should be aware of topics that should be avoided?
What are some of the current problems/challenges/breakthroughs experienced by your attendees, industry, organization, association or people?
What are 3 concepts or take-a-ways can Dr. Bridget deliver that will allow your attendees, industry, organization, association or people to maximize their performance.
Please verify that you are human *
Thank you for submission. A member of our management team will be in touch with you shortly.
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Speaker Request Questionnaire