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Upcoming Events

Booking and Consultation Requests

Please complete the form below and someone will be in contact with you within 48 hours!

Date

Date of Request

YYYY

Date of Event

YYYY

Host/Organization Name

Please specify the requesting organization.

Name

First Name

Last Name

Phone

Country

(###)

###

####

Venue Name

Venue Address

Please provide the venue address. if online request, please specify online and place address of requesting organization.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Event Details (Please provide approximate number of attendees, length of time request to speak)

Event Type

Event website address

Closest Airport/Station

Speaking Fee Budget

Note: This fee budget covers the time and preparation needed to fulfill the requested participation, as well as the time required to travel to the and attend your event does not include the costs for lodging, and ground transportation, meals, assistants, etc.

Confirmed Additional Speakers if Applicable.

How would you like for Dr. Michelle to participate in your event?

Please specify what role you would like for Dr. Michelle to participate in your event.

Would materials or assistance from Dr. Michelle Harris need to be provided to ensure your event is a success (handouts, small gifts, etc.)? If so, please specify..

Any additional information or request, please provide below:

Deadline to Respond

How did you hear about Dr. Michelle? We would love to thank who referred you to her. if applicable.

Please select yes to confirm submission.

By clicking yes, you agree to the terms and conditions of the specified contract if developed.