Request Dr. Akua

Please list the event where you met Dr. Akua. If this is a referral, please list who referred you. *

Briefly describe event type, theme, purpose, target audience: *

I am interested in:

Purchasing Dr. Akua Books or Resources

Registering for a Webinar Series

Attending a Teacher Transformation Institute

Learning More About Dr. Akua

Expected Attendance: *

Target Date: *

Organization/Institution City & State: *

Contact Person: *

Cell Phone: *

Type of presentation requested, Check all that apply: *

Keynote Speech

Conference Workshop

Professional Development

Presentation to Students

ParentPower! Presentation

Dr. Akua Presentation/Information Request Form

Email: *

Organization/Institution Name: *