Looking for a speaker for your next event? Let’s get started!
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Company/Organization
*
Status of Company/Organization
*
For Profit
Non-Profit
Government Entity
Non-government Entity
Name of Event
*
Ex: Brunch, Workshop, Conference
This Event Will Be:
*
In-Person
Virtual
Date and Time of Event
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Event Address/Location
*
Type of Event
*
(Ex: Brunch, Workshop, Conference)
Expected Number of Attendees
*
Please List any Event Sponsors
Media: Will media be invited? If so, please provide media list.
Cost of Attendance
*
Please include member and non-member pricing, if applicable
What is Your Speaker Budget?
*
Duration of Speaking Time
*
Speaker Start Time
*
Hour Minutes
AM
PM
AM/PM Option
How Would you Like Stephanie to Contribute to Your Event?
*
Keynote Speaker
Workshop Facilitator (non-Gottman)
Gottman Seven Principles Workshop
Trainer
Panelist
Host/MC
Other
Presentation/Speech Topic Preferred
(Ex: Mental Health, Healthy Relationships, etc)
Will There be a Q&A Session?
*
Yes
No
Will I be Allowed to Promote Products/Services?
*
Yes
No
...Let's Discuss it!
Deadline for Acceptance
*
Please provide exact date and time including time zone
How Did you Hear About me?
*
Any additional information for the speaker’s consideration?
*
SUBMIT REQUEST
Should be Empty: