Education and Lecture Request

Thank you for your interest in Kylie the RD. Please complete this form and Kylie will respond soon to confirm plans with you.

First name

Last name

Company name

Email

Phone

Location for educational event. If virtual, please write the platform or ap to be used.

Select at least one possible date and time for your educational event. We'll try to schedule your first choice if it's available.

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Date and time

:

Date and time

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What general topics would you like to discuss?

Please describe the group of attendants for this event including the number of people and their approximate ages.

Please list and describe any specific health concerns or goals that this event should address.