Speaking Request

Need a speaker for an upcoming event?

If you would like to book Dr. Sheri Keffer for an upcoming event, please fill out this form and we will get in touch with you shortly.

Date*
MM slash DD slash YYYY
Contact Person's Name*
First Last
Contact's Phone*
Contact's Email*
Organization's Name*
Website
Name of Event*
Date of Event*
MM slash DD slash YYYY
Time of Event

:

AM/PM
Event Location
(i.e. building or location name)
Event Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Budget Amount*
Audience Size*
Proposed Topic(s)*
Length of Presentation
(requested time length if known)
Presentation Format
(i.e panel, speech, roundtable, etc.)
Will this event be recorded/video-taped?*
- Yes
- No
- Not sure at this point
Additional Comments
Name
This field is for validation purposes and should be left unchanged.