Workshop Request

Thank you for your invitation. Please note that Dr. van der Kolk has a busy international speaking schedule and a full weekly agenda. Due to the high volume of incoming requests, you may experience a delayed response. Thank you for your understanding!

Date of event

Important deadlines we need to be aware of

Type of event

Theme/title of the event

Anticipated number of attendees

Event location

List all commitments you would like considered. (ex: 1 day, workshop 9-3pm, anytime in 2025)

Briefly describe what you would like Dr. van der Kolk to present

Name of Organization

Website

Organization's mission

List other key speakers who might be presenting at the event

First Name

Last Name

Phone Number

Address

City

State

Postal Code

Country

Attach brochure from last year

Comments: Please include any other pertinent details, and information on Honorarium, accommodations, and travel reimbursement

If Dr. van der Kolk is unavailable, would you like to receive a referral?

Workshop Request

Workshop Request

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