Appearrance Request

Thank you for your interest in inviting Dr. Charles Modlin to participate in your event. To help us properly review and coordinate your request, please complete the Appearance Request Form in full.

The information provided will help determine Dr. Modlin’s availability and ensure that the event aligns with scheduling, travel, and presentation requirements.
Please include the following information: in the provided form
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Please submit your request as early as possible to allow adequate time for review and scheduling. Submission of the form does not guarantee availability or confirmation of participation.
A representative will review your request and respond regarding availability, additional information, and next steps.
We appreciate your interest in having Dr. Charles Modlin participate in your event and look forward to learning more about your program.

Request Form

Name
Contact Person
Event Information
Event Date / Time
Address
Target Audiance
Will Travel Accomadations be Provided?
Will Hotel Accommodations be Provided?
Audio / Visual Equipment Available
Please provide any additional details regarding your event, audience, or special request:
By submitting this form, you understand that submission does not guarantee speaker availability. A representative will contact you regarding confirmation and additional event details
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