Linda Hodgdon M.Ed., CCC-SLP

Speech Pathologist

Consultant for Autism and Related Disabilities

 

P.O. Box 71, Troy, MI 48099-0071

Phone:  248-879-2598   Fax: 248-879-2599

email  linda@lindahodgdon.com

Website: www.lindahodgdon.com

 

 

 

Linda Hodgdon Speaking Engagement Request Form

 

 

Please fill out this form, print it and fax to 248-879-2599.

Or download the printable version, fill-in information required

and fax to 248-879-2599.

That will help us get started. 

I will contact you to discuss the details.

 

Download Printable Form

 

Date:         

 

Request made by (Name):
(Position):
Organization:
Contact person (if different from above):
Best time to call:

 

 

Contact Information:

 

Address:
City:
State:
Zip:
Phone:
Fax:
Email:

 

When are you planning for?

 

Desired date:
Do you have flexibility regarding date?
Comments:

 

Where will the program be held?

 

City:
State:
Country:  (if outside US)
Program site:
Closest airport:
Maximum driving time from program site to airport:

 

 

Program: (Mark answer with an X)

 

What type of program are you interested in?

 

Full Day    Short Presentation   Keynote   Other (please describe):

 

Please describe purpose of program:

Conference    In-service Training    Other (please describe)

 

 

How many people are you planning for?   

Please describe the audience:   

 

Is there anything additional we need to be sure to talk about?  

   

I will try to contact you within a couple of days of receiving this information. 

Please be patient.  If I am out of town, it may take just a bit more time.

 

I look forward to the possibilities.