Lakiesha Russell Speaker Request Form
Thank you for your interest in having Lakiesha Russell, LPC speak at your upcoming event. In order to help us facilitate your request, please complete and submit the following form at your earliest convenience.
Email *
Today's Date *
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Type of Request *
Required
Theme for Event *
Name of the organization submitting the request *
Company URL & social media handles *
Contact Name & Title *
Email *
Phone *
Event Name *
Event URL (if applicable) *
City, State *
Event Date *
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Event Start Time *
Time
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Event End Time *
Time
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Venue Location *
Audience Information (demographic : race, gender, age,etc., expected audience size) *
Is there a cost for attendees for this event? *
Will there be a photographer and/or any other media? *
Will speaker be expected to do media interviews? *
Please detail any requests for social media promotion (Instagram, Twitter, Facebook & the frequency) *
What is your speaker budget? *
Is travel and hotel assistance provided separately from the speaker budget? *
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