Request Dr. LFM to Speak
We are honored that you would consider Dr. Lesley for your event! Please fill out the following information and a member from our team will be in contact within 2-3 business days.
Who are You Inviting To Speak?
First Name
Last Name
Your Name
*
First Name
Last Name
Your Contact Email
*
example@example.com
Your Contact Phone Number
Name of Organization
*
Organization Website
*
Name of Requested Event or Conference
*
Theme(s) and/or Focus of Gathering
Date of Event
*
/
Month
/
Day
Year
Date
Expected Number of Attendees
*
Event Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Will an Honorarium be Provided?
*
Yes
No
Will Hotel and Travel Expenses be Provided or Reimbursed?
*
Yes
No
N/A
Number of Speaking Sessions Requested
*
Please List The Day(s) and Time(s) You Would Like to Speak
Can Dr. Lesley bring product for sale?
*
Yes
No
Additional Relevant Information or Requests
Submit
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