Cooper Aerobics Speaker Request Form

Speaker Request for Cooper Experts

Cooper Aerobics is home to a variety of health and wellness experts. We provide speakers—physicians, personal trainers, dietitians, wellness coaches and more—for conferences, meetings and groups of all sizes.

All speaker requests must be submitted at least two months prior to the event. We will email you to let you know if we accept or decline your request.

First Name:*	Last Name:*

Title:*

Company Name:*

Street:


City:	State:


Zip/Postal Code:	Country:

Daytime Phone:*

Email:*

How do you prefer to be contacted?*

Phone

How did you hear about us?*

Presentation Specifics

Event Name:*

Location:*

Audience Size:*

Presentation Date:*

Presentation Time:*

Presentation Length:*

Topic(s):*

Budget for Speaker/Travel Expenses:*

Please provide any additional information or questions.