Book A Speaking Event | High Performance Living and Motivational Speaker

Thank you for your interest in having Dr. Lepora speak at your event!

Please complete the following survey and we'll respond to your request as soon as possible.

Thank you!

Name

Organization

Email Address

Phone Number

Website

Name of Event

Please provide the name, date and location of the event

Location of Event

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Event

YYYY

Please Describe the event:

Please provide the length of time you would like Dr. Lepora to speak:

What would you like attendees to gain from this event?

Please describe your audience demographic (i.e. age, geographic region, psychographic profile, etc):

What is you speaking budget range?

Is this the first time you are hosting this event

Yes

If no, how many attendees did you have at the last event?

How many attendees are projected to come?

Are you selling products or programs at the event

Yes

Will we be able to sell our products and programs at the event?

Yes