Interested in having Debbie speak at your event?
Please complete the form below so we can get to know you and your event in greater detail.
Name:
First Name
Last Name
Email:
example@example.com
Phone Number:
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Area Code
Phone Number
Event Website/Company Website:
What is the name of the event?
What topic are you interested in me presenting?
Advance Directives and Planning
Advocating for Your Loved Ones
Caring in the Chaos of Today’s Healthcare
Control Your Aging Years
Family Feuds in Healthcare
Preparation During Incapacity
Tension Between Medical & Legal
Understanding Guardianship
Topic Customized to Your Audience
Where is the event being held?
Leave this blank if the location has not yet been set.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Proposed date of the Event:
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Month
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Day
Year
Date
Duration of Debbie's talk.
30 minutes
45 minutes
60 minutes
90 minutes
How many attendees are expected?
1-100
100-200
200-400
500+
Will there be an opportunity to sell books/other products at the event?
Yes
No
Let's Discuss
Will travel expenses be covered by the event? (If required)
Yes
No
Let's Discuss
Budget/proposed fee:
Why do you think Debbie would be a good fit as a speaker for your event?
Is there anything else we should know?
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