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Motivational Speaker Request Form

Nicole J. Phillips

Champion for Kindness, Breast Cancer Survivor
The Negativity Remedy

Motivational Speaker Request Form - Speak Well Being

If you're looking for a motivational speaker, you're in the right place. You may have a particular speaker, theme or topic in mind -- whether it's general or specific, we're good listeners and will put our expertise to work for you to come up with the perfect fit.  By giving us your parameters below, we can get started. At the end of the form, there's a place to give us additional information about your organization, type of event, previous speakers, event goals, etc. All of the information you can provide is helpful in guiding us to recommending the perfect speaker for your event.

  • Speaker Info

  • Contact Information

  • Speech/Appearance/Event Information

  • MM slash DD slash YYYY
  • Providing your speaker budget information will help us tailor our search for you.
  • Information about your organization, type of event, previous speakers, event goals, etc., is helpful in guiding us to recommending the perfect speaker for you).
  • This field is for validation purposes and should be left unchanged.

Let Us Know How We Can Help You

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Email:
barbara@SpeakWellBeing.com
Address:
Portland, Oregon

We look forward to connecting with you

If you are an event planner, put our expertise to work for you to connect you with a fabulous motivational keynote speaker for your conference or special event. Contact us now by phone or email for immediate assistance. If you are a speaker seeking representation, please include your website address, and video links with your inquiry.

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