SpeakingRequest

Interested in having Dr. Rodriguez speak at your event? Please fill out the form below and someone will get back with you...


Your Name (required)


How should we contact you?

If you want someone to contact you by email, please provide your email address:

Your Email:

If you want someone to contact you by phone, please provide your phone number and the best time to contact you:

Your Phone Number:

Best Time to Contact You:

Please provide some information about the event:

Event Name:

Event Date (specific date or date range):

Event Theme:

Any other information you want Dr. Rodriguez to know about the event (this would be a great place to tell Dr. Rodriguez what topic you'd like addressed:

How did you find Dr. Rodriguez (check all that apply):


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