Speaker Engagement Form

Thanks for your interest in booking Dr. Shannon Bauman or one of the other Concussion North team members to speak at your event. To get the booking ball rolling, please complete the following Engagement Form and we will get back to you right away to finalize the details.

Name

First Name

Last Name

Email Address

What is the name of your event?

What is the date and time of your event?

Which topic(s) are you most interested in?

Who will be attending the event? (Tell us about the audience.)

Why is Dr. Bauman/Concussion North a good fit for this event/audience?

Is there anything else you'd like to share with us about the event or your presentation needs?