Speaker / Workshop Request Form

Part 1: Event Organizer


Please submit this completed form and any corresponding attachments to
info@myrulesmyreality.com.

Please submit speaking /workship request at least 2 weeks prior to the event.
Please allow 3 to 5 business days for a decision to be made

If you have any questions or need help completing the Speaker/ Workshop Request Form, please call
My Rules, My Reality, Inc at 407-844-6578.

Part 2: Event Details

Part 4: Audience Details

Part 5: Additional Information

Thank you for your interest in having a My Rules, My Reality, Inc, speak at your event. In
order to help us facilitate your request, please complete and submit the following form (and
any corresponding attachments) to info@myrulesmyreality.com at least 2 weeks prior to the
event, and allow 3-5 business days for decisions to be made.

If you have any questions or need help completing the Speaker/ Workshop Request Form, please
contact My Rules, My Reality at 407-844-6578.

Part 3: Presentation/Speech Details