Casondra E. Burkley-Booking Form

Casondra E. Burkley-Booking Form

Thank you for your interest in booking Casondra E. Burkley, LCSW-S, M.Div, CLYSSB. Please complete this form in its entirety. Casondra will contact you within 48 hours to discuss your booking request.
Full Name*

PrefixFirst NameLast Name
Email*
example@example.com
Company/Organization Name*
Phone Number*
Please enter a valid phone number.
Name of the Event*
Date of the Event*

MonthDayYear
Date
Time*

Hour Minutes

AM/PM Option
Address of the Event*

Street Address

Street Address Line 2

CityState / 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 SpeakerWorkshop FacilitatorTrainerPanelistPodcast GuestSocial Media GuestTV Show GuestZoom / Virtual Platform GuestOther
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?*

YesNoLet's Talk About It
Will Travel and Lodging Accommodations be Needed? Please Keep in Mind that Casondra is Located in Houston, Texas.*

YesNo
Should be Empty: