Speaker’s Request Form

Request a speaker for an upcoming screening, meeting or event! Complete the form below at least 14 days prior to your event. Please feel free to contact us at info@charlotteresilienceproject.org with any questions. For more information on the Charlotte Resilience Project Speakers’ Bureau, click here.

Name *
Name
Phone
Phone
Please highlight the desired topics of focus (ACEs, Toxic Stress, Trauma, Resilience, All)
Date of Event
Date of Event
Time
Time
Please include address and any special parking instructions
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Please include the amount of attendees and demographic information.