Request a Speaker

Request an HMI speaker for your upcoming event using the form below. To help us best identify the ideal speaker for your event, please complete all details below.

Speaking Engagements

First Name *

Last Name *

Email *

Organization *

Phone *

Organization Website *

Event Title *

Event Website *

Date & Time of Speaking Engagement *

Length of Speaking Engagement *

Event Location *

Requested Speaker *

Please explain the speaker’s possible topic(s) *

Please explain the purpose of the event *

Please describe the audience and expected attendance *

Honorarium amount *

How did you hear about Healthy Minds Innovations and/or the Center for Healthy Minds? *

Marketing Permissions

HMI will use the contact information you provide on this form to send you updates and marketing communications.

By checking the box below, you consent to receive marketing communications via email to the email address provided above.

You can withdraw this consent at any time by clicking the unsubscribe link in the footer of our emails, or by contacting support@hminnovations.org. For additional information on our privacy practices, please review our privacy notice.

We use Mailchimp as our marketing platform. By clicking below, you acknowledge that your information will be transferred to Mailchimp for processing. Learn more about Mailchimp's privacy practices here.

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