Speaker Request

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Please complete the contact form below to make a request for BG (Ret) Julia J. Cleckley’s presentation at your event
(i.e. keynote speaker, speech, book talk, mentoring, panel participant, etc).

We look forward to working with you.  If you have any questions, please don’t hesitate to contact us at (703) 509-6742
or (216) 235-3037.

* Name of Hosting Organization

* Date/Time of engagement: (Your first choice including the year):

* Alternate dates available (Include the year):

* City and State where engagement will take place:
     

If this event is taking place outside of the United States, please enter the city and country in the text box above and select N/A from the drop down box.




Name of the hotel, convention center, etc. where engagement will take place:

Hotel where speaker will stay during their travel to your engagement:

* Fee Negotiable:




* Travel expenses (Select one of the choices below):

Other:




* Schedule:

Please include any activity you wish the speaker to participate in when agreeing to this invitation. Be sure to indicate optional activities by writing "Optional" next to that event, including exact times.

* Tell us about this event and what you'd like the speaker to talk about.

* Provide us with some background on the hosting organization.

* Approximately, how many people will be in the audience and who will they be?

Will your event be open or closed press? If open, please provide any relevant details.

Anything else you'd like the speaker to know about you and your event?




* Your Name

* Your Title

* Phone Number (xxx-xxx-xxxx)

* Email Address

* Mailing Address

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Contact Us

Thank you for a very dynamic speech which you presented at the Top Ladies of Distinction, Inc, Tea in San Francisco. You truly are an inspiration and motivator for our young women and men. Your commitment to excellence, education, and diversity really came across in your speech. You left the audiences charged to go out and make a difference.

Rose Toney, President

We Check on You -
San Francisco, CA

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