Speaker Request Form

Thank you for your interest in booking Regina L. Lacking for your upcoming event. Please complete the following form to request a speaking engagement for No Flinch Faith: Stop Flinching When It Comes to Your Health or one of Regina's signature talks.

CONTACT DETAILS

First Name

Last Name

Organization (if applicable)

Phone number

EVENT DETAILS

Event Name

Event date

Event location (City/State/Venue or Virtual)

Expected Audience Size

Audience Type (e.g., corporate, faith-based, health professionals, general public, mixed audience)

Event Theme/Purpose

SPEAKING TOPICS

Select one or more:

No Flinch Faith: Stop Flinching When It Comes to Your Health

DIET OVER DNA: The Truth about the Matter

Doing Life Well in the Workplace: Strategies for a Thriving Workforce

4th Quarter Mindset: The Coach’s Playbook for Success-Keeping Your Team Engaged While Navigating Competing Priorities

Custom Topic (Please specify):

CUSTOMIZATION

Do you have specific pain points you’d like Regina to address? (e.g., weight loss, stress, workplace wellness, employee burnout, productivity, etc.)

Would you like a Q&A or interactive portion included?

Yes

LOGISTICS

Speaking Duration (e.g., keynote, workshop, panel discussion):

AV Requirements (e.g., microphone, projector, slide presentation):

Will travel expenses be covered?

Yes

Budget for speaker fee:

ADDITIONAL COMMENTS

Once we receive your request, Regina will review the details and follow up with you to schedule a suitability call.

Please use the link below to book your suitability call.

Thank you for considering Regina L. Lacking to speak at your event!

Doing Life Well

Speaker Request Form

Thanks for submitting!