Speaker Request Form

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Speaker Request Form

Please complete the request form below for The S.E.L. Group to gain clarity on details of your request. Once we receive this form, the business contact person listed below will receive a quote for prospective services within 5 business days.

Enter infomation below

* Indicates required field

Event Name / Theme *

Event Date *

Event Time *

Event Location *

Contact Person *

Phone *

Email *

Possible Topics of Discussion *

Anxiety Depression Mental Health and Wellness Mental Health and Faith Family and Relationships Children and Youth Concerns Stress Management Couples Concerns Other (write more details below)

Group Size *

Small Group (15 or less) Large Group (16 or higher)

Technology Available (select all that apply) *

Laptop / PC Wi-Fi Connection Projector with HDMI Connection Projector with RGB Connection Smart TV with HDMI Connection Speakers

Is the speaker needed for a keynote address, concurrent session, or other (please explain)?

Notes *

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Look for something positive in each day, even if some days you have to look a little harder. Let challenges make you strong.

Home
About Us
Services Offered
Fees and Insurance
Contact Us

​Speaker Request Form

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Speaker Request Form