Creative Neurology-Speaker Request Form
Please fill out this form if your organization would like Creative Neurology to give a presentation on either the benefits of art and Parkinsons (other Neuro disorders) or on our Let's Combat Micrographia program. Both speaking engagements are geared to educate an audience so they walk away knowing more about the benefits or art and what micrographia is. Our presentation is one hour long and we leave the last 15 minutes for Question and Answer Period.

Please note as we use our expertise and experience to deliver this presentation to your group, we do require a small fee of $100 to help cover the cost of the time and effort it takes our employees to prepare a presentation and deliver the presentation. This fee is only applicable to Zoom or online speaking engagements for small groups of 10 people or less.

Alternatively, groups of 10 people or less may also purchase merchandise from our online Let's Combat Micrographia store. The purchase must be greater than or equal to 100.00. Additional shipping fees may apply for non-book items.


For any larger groups please email us at livebetter@creativeneurology.com for pricing.

Email *
Please tell us the name of your organization
Please provide the name, email, and phone number of one contact person who we will communicate with to set up this talk.
Is your organization linked to a specific Neuro disorder?
Where are you located?
Which time zone?
Are you interested in a talk on the Smile Through Art program and benefits of art or the Let's Combat Micrographia program and what micrographia is?
Clear selection
How many people are expected to join and listen to the talk?
Do you prefer Zoom or in person?
Clear selection
Please provide 3 dates and times that work for your group. Please note we do our best to try and accommodate your time preference.
Would you like flyers to share with your group regarding our programs?
Clear selection
Will you be paying the 100.00 fee or purchasing merchandise from our online store?
Clear selection
Please include any other relevant information
Submit
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