Speaker Request Form
Thank you so much for your interest in having Jen Haefele, RDN, CDN, CEDRD speak at your next event. 
Please fill out the following form and we will be in touch soon.
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Email *
Name (First and Last) *
Phone Number *
Organization (if applicable)
How did you hear about us? *
If it was a provider or a higher level of care please list here.
Please describe the event for which you are requesting a speaker *
Approximate size of the audience *
Age range of the audience *
Any special characteristics of the audience  *
Time frame of the speaking engagement (i.e. day and length of time speaking) *
Virtual or In-Person *
I acknowledge that Jennifer Haefele does not give presentations on weight loss and presents all nutrition topics from a Health at Every Size lens. 
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