Speaker Booking Form
Thank you for your interest in booking Casondra E. Burkley, LCSW, M.Div. Please complete this form in its entirety. Casondra will contact you within 48 hours to discuss your booking request.
Full Name
*
Prefix
First Name
Last Name
Email
*
example@example.com
Company/Organization Name
*
Phone Number
*
Please enter a valid phone number.
Name of the Event
*
Date of the Event
*
-
Month
-
Day
Year
Date
Time
*
Hour Minutes
AM
PM
AM/PM Option
Address of the Event
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Event Description
*
Expected Number of Attendees
*
What is your Speaker Budget
*
How would you like Casondra to contribute to your event?
*
Keynote Speaker
Workshop Facilitator
Trainer
Panelist
Podcast Guest
Social Media Guest
TV Show Guest
Zoom / Virtual Platform Guest
Other
How Long Will You Need Casondra to Speak?
*
What Topic Would You Like Casondra to Speak On?
*
Will Casondra be able to promote any of her products/services?
*
Yes
No
Let's Talk About It
Will Travel and Lodging Accommodations be Needed? Please Keep in Mind that Casondra is Located in Houston, Texas.
*
Yes
No
Submit
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