Simplee Therapy Speaker Request
Thank you for your interest in having a speaker from Simplee Therapy at your event. Please fill out the form below so we can connect about your needs for your event.
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Email *
Info about Event
Please help us paint the picture of the event and your needs.
Full Name of Contact Person *
Phone Number *
Best Form of Contact *
Will event be held in person, virtually, or hybrid? *
Location of Event (City, State, Country)
Event Name *
Event Description
Date of Event *
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Time of Event *
Time
:
Length of Event *
How long have you been hosting this event? *
How often is this event held?
Clear selection
Who would you like to speak at this event? *
Speaker Budget *
Will there be other presenters/speakers at the event? *
What topic(s) will be discussed at the event?
Will the event be recorded/photographed?
Clear selection
Will we have access to the recording/photographs of our presentation after the event?
Clear selection
Info on Audience
Who are the lovely people participating in your event?
Audience Demographics Description
Audience Size *
Is this event an Inclusive Space? *
Required
Info on Speaker's Role
Let us know what you need from us!
What Type of Service would you like Simplee Therapy to Provide? *
Length of the Talk *
Will we be provided with appropriate equipment for our participation? *
Required
Will we be required to participate in other aspects of the event?
Clear selection
Would you like us to participate in any form of marketing for the event?
Clear selection
Thank you!
Thank you for taking the time to provide us with this information! Someone will contact you in the coming days to discuss Simplee Therapy's potential participation in your event.
A copy of your responses will be emailed to the address you provided.
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