Speaker Request FormDr. Britt is a therapist, speaker, educator, and writer. She welcomes the opportunity to encourage, inspire and educate others regarding all things grief/loss and mental/emotional health related. Please complete the following information regarding your request to have Dr. Britt speak at your upcoming event, provide a workshop, or provide consultation for your behavioral health business. For any other business inquiries still complete this form. Dr. Britt cannot wait to connect with you! Upon completing the form, we will get back to you within 24 to 48 hours regarding your event. Due to Dr. Britt’s schedule, we ask that you give us at least 30 to 60 days’ notice prior to your event. Thank you in advance.Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. of or Are Name *FirstLast Email *Company / Organization *Name of EventAddress LocationDate and Time of EventType of EventExpected Number of AttendeesAre you charging attendees? If so, how much?What is your speaker budget?Your Contact NumberHow would you like Dr. Britt to contribute to your event?Keynote SpeakerWorkshop FacilitatorPanelistHostTrainerOtherPlease specify other:How long will you need Dr. Britt to speak?Will Dr. Britt be able to promote her products, books or services?YesNoWill Dr. Britt be able to promote her products, books or services? (Dr. Britt is located in NJ)YesNoAny additional information that you would like for me to know or consider?Submit