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Lyme Education Speaker Request Form
Day of Event
When will your event take place?
Time of Event
What time will your event begin and end?
Alternate Day of Event
When is another day that works?
Alternate Time of Event
When is another time that works?
Type of event (location)
What kind of event is this?
Address of Event (for in-person events)
Address Line 1
Address Line 2
Is parking available?
For in-person events
Allotted time for speaker
30 minutes, 1 hour, etc.
Who will we be speaking to?
Please select a topic you would like our speaker to present on:
Healing Light Meditation
Lyme Play, The Great Imitator
Stories of Hope
Foods That Help Recover From Lyme Disease
Psychotherapy, Coaching, Journaling
Get Rid of Ticks in Your Yard
Disability Disclosure on Job Applications
I'm Not Crazy, I'm Sick