Request a Speaker
Speaker Contact Inquiry
Contact Information
Organization Name
Please enter your Organization Name
First Name (*)
Please enter your first name
Last Name (*)
Please enter your last name
Please enter your Title
Email (*)
Please enter a valid email address
Work Phone (*)
Please enter your work phone
Cell Phone
Please enter a valid cell phone number
Meeting Date
Please select your meeting date
Meeting Location
Invalid Input
Do you have hiring authority? (*)
Please select if you have hiring authority
If you do not have hiring authority, please provide the following for the individual with hiring authority:
Hiring Authority Name
Invalid Input
Hiring Authority Title
Invalid Input
Authority Phone
Invalid Input
Hiring Authority Email
Invalid Input
What else would you like Laura to know about
your organization?
Invalid Input

Program & Budget Information

I would like to hire Laura for: (*)

Please make a session selection

Which Programs Are You Interested In? (Check all that apply)

Eliminate Chaos Series

Invalid Input

Information Strategies for Microsoft Outlook Series

Invalid Input

Home-Based / Small Businesses Series

Invalid Input

Why did you select this topic?
Invalid Input
What is your desired program length? Select one: (*)
Please select a program length
What is your budget for this event? Select One: (*)

Please select your budget

Audio/Visual Information

Will a LCD projector be available? (*)
Please select if a projector will be available
Will a wireless lavaliere be available? (*)
Please select if a lavaliere is available

Laura’s Books

Please check one of the following:

Invalid Input

Please fill in the numbers from the image Please fill in the numbers from the image
Please fill in the numbers into the box above. This is to prevent abuse of the form