Speaker Request Form

We would love to speak for you!

The Youth Success Doctor and The Youth Success Princess are currently scheduling speaking engagements for 2012-2013.

Please complete the Contact Form below to tell us about your event. It will expedite our response if you include a brief description, event date(s), talk topics and speaker requested.

Your First & Last Name (required)

Your Program Name (required)

Your Email (required)

Your Phone (required)

Subject Line

What is your speaker budget?

Who is the target audience?
 Youth Parents Educators Mentors Other

Please provide additional event details, event date(s), talk titles and speaker(s) requested.

Your Message

Thank you for your interest!

 

We can also be reached by mail, email and phone.

Empower More Youth, Inc.
P.O. Box 44572
Washington DC, 20026

Office: (855) EM-YOUTH
support(AT)empowermoreyouth(DOT)com