Speaker Booking Form

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 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
Should be Empty:

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