• Speaker Request

    Speaker Request

    Please complete the form below submit a speaker request.
    I will try my best to accommodate your request and will be in touch ASAP.


    Imagine Life in Your Moment

    By submitting this form via this web portal, you acknowledge and accept that risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.