Speaker Request Form

Thank you for your interest in booking Dr. Tashina Reeder for your upcoming event! Please complete the form below to help us better understand your needs and determine the best way to support your audience.

Contact Information

Full Name *

Organization *

Email *

Phone *

Website or Social Media (if applicable)

Event Details

Event Title *

Event Theme/Focus *

Event Date(s) *

Event Time(s) *

Location of Event *

Venue Name

Audience Information

Expected Audience Size *

Audience Type *

Has this event been hosted before? *

Yes

If yes, how many years?

Speaker Logistics

Requested Role for Dr. Tashina Reeder *

Keynote Speaker

Workshop Facilitator

Panelist

Emcee/Host

Other

Length of Speaking Time *

Will this be a paid speaking engagement? *

Yes

If yes, please provide your speaker fee budget range

Will travel expenses be covered? *

Yes

Will hotel accommodations be provided? *

Yes

Additional Notes

Message

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.