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If you would like to request a Leader Dog representative to speak at an upcoming event, complete the form provided below. In order to allow us to serve you better, please submit requests 30 days in advance of the event date, when possible.
We will do our best to accommodate your request, but we cannot guarantee that a speaker will be available for the requested date or location.
Please complete the required items on the form below.
First name (required):
Last name (required):
E-mail address (required):
Club affiliation (required):
District affiliation (required):
Phone (required):
Event name
Date (required):
Time (required):
Address: Address 1 Address 2
City (required):
State (required):
Zip code:
Expected attendance (required):
Additional Information:
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