Request a Speaker/Training

Thank you for your interest in having “Breaking the Chains” present for your organization.

Company/Organization*
Name*
First Last
Email*
Contact Number*
Event Date*
MM slash DD slash YYYY
Event Time*

: Hours

Minutes

AM/PM
Length of Time*
Length of time needed to speak.
Event Location*
Topic or special instructions for speaker
Speaker Requested
First Last
Please Note: A speaker stipend is encouraged for all events. Additionally a mileage charge is applicable for engagements more than 10 miles outside of Fresno City Limits.
Section Break

Need a speaker?