Speaking Engagement Request
Thank you for your request for Dr. Elisa LaShell Harney to speak at your upcoming event.

Many details go into booking a speaker. Please understand that this request form serves as a request for information only. It neither constitutes a confirmation of Dr. E to appear nor does it bind you to have her speak. It will assist us in making the best decision possible while doing all we can to meet your request.

Thanks for giving us the opportunity to serve your organization!

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Thank you,
The Empowerment Specialist® Booking Team
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Email *
Date of Event Request *
MM
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DD
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YYYY
Time of Event *
Time
:
Is this a Live or Virtual engagement request? *
What type of presentation will you host? *
What type of presentation are you requesting *
Please provide a description of the event. *
Please describe the nature of the speaking request. Please include information such as, is there an event theme? What are the event colors, if any? What topic should Dr. E prepare to speak on? *
What is the area of focus? *
Organization Name. *
Organization Website and Social Media Handles. *
Event Address or Platform (Virtual Event). If the venue has not been confirmed, please provide the projected city & state or virtual platform. *
Estimated Attendees/Participants. *
What is the proposed length of the talk/training? *
Projected Time of Speaker's Appearance, if different from start time of the event. *
Time
:
Name of Contact Person(s). *
Contact Telephone Number. *
Contact Email Address. *
What is the requested offer/budget for the speaker? *
A copy of your responses will be emailed to the address you provided.
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