Speaker Request
Thank you for considering us for your event. Please fill out the form below to provide details about your request.
Request for
Brittney Wardlaw, JD & G.P. Wardlaw, LMFT-S, LPC-S
Brittney Wardlaw, JD
G.P. Wardlaw, LMFT-S, LPC-S
Name
First Name
Last Name
Organization
E-mail
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about our us?
Speaking Engagement
Website
Word of Mouth
Social Media
Youtube
Other
Name of Event
Topic
Event Location
Date(s) of your event
Are these dates flexible?
Event Duration
Will you charge a fee to attend your event ?
How many are expected to attend your event?
Who else is going to be speaking at the event?
What is the budget for a speaker fee?
Is there a budget for transportation, lodging, flights, etc?
Can I sell merchandise? Do giveaways?
Will there be technology available to support a slide presentation (e.g., PowerPoint), whether in-person or virtual?
Yes – the speaker can share their screen or connect to a projector
No – presentation support is not available
Not sure – we’ll follow up with more details later
Why do you think I'm a great fit for the event?
Additional Information
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