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Speaker Request


Please complete this form to request Dr. Deas as a speaker for your event.

*indicates required fields 
  *Name:
  *Co./Org.:
  Title:
  *Phone:
  *Email:
  *Specific Event in Mind:
  *Topic(s):  Mental Health
 Marriage & Family
 Team Building
 Motivational Training
 Leadership Development
 Adolescents
 Other - to be discussed
  *Date of Event:
  *Audience Size:  under 50
 50-500
 500 +
 Don't Know Yet
  *Location of Event:
  *Your Budget $:

After filling in the details click on the SUBMIT button then click reset.
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