Speaking Engagements Inquiry

Looking To Hire A Panelist, Facilitator, Speaker, Or Presenter? Fill out the form on this page to send in your Speaking Engagements Request.

First/Last Name

Email

Company/Organization

Phone Number

Status of Company/Organization*

For Profit Non-Profit

Name of Event

Date and Time of Event*

Address/Location

Type of Event* (Ex: Brunch, Workshop, Conference)

This Event Will Be:*

This Event Will Be

In-Person Virtual

Expected Number of Attendees

Please List Any Event Sponsors*

Media: Will Media Be Invited? If so, please provide the media list.*

Cost of attendance (please include member and non-member price, if applicable)

What is your speaker budget?* (include exact $ amount or range)

How would you like for Candace to contribute to your event?*

Keynote Speaker Workshop Facilitator Trainer Panelist Host/MC Other

How long will you need Candace to speak?*

Presentation/speech topic preferred* (Ex: Mental Health, Healthy Relationships)

Will this speech be followed by a Q&A session?*

Yes No

Will Candace be allowed to promote any of her products/services?*

Yes No ...Let's Discuss It!

Will travel accommodations be needed?

Yes No N/A

Deadline for Acceptance* (please provide exact date)

How did you hear about Candace?*

Any additional information you would like for Candace to know or consider?

Get started with Jurnee Mental Health Consulting today to learn how we can help you or your organization.