Brianna Henderson Booking Form

Booking Agreement

Complete form below to retain the services of Brianna D. Henderson
For Direct Inquiries contact the main representative at admins@letstalkppcm.org or call (214)-412-5378

*Rate is confirmed upon booking.
Your Name

First NameLast Name
E-mail
example@example.com
Phone

Area CodePhone Number
Event Date & Time

MonthDayYearHourMinutesAM/PM Option
We are booking Brianna for
Name of Event
Name of Venue
Venue Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Event Attire
Honorarium Pricing

Prices based on engagement length and do not include travel cost. Up to 50 participants=$25/per | Up to 100 participants=$25/per
Please select an option:
prevnext( X )
Patient Advocate$30.00

Certified Family Partner$500.00

PPCM Screening Course$1,100.00

PPCM Workshop$1,250.00

Panel Discussion$2,000.00

Guest Speaker$3,500.00

Short Film Video Rental$3,600.00
12 month bundle.

Keynote Speaker$4,000.00

Total $0.00
Type a question
Other Arrangement
A 50% Non-refundable retainer is required to guarantee speaking date.
Travel Arrangements
Please select an option
Payment Terms

Please check to show your understanding and agreement with the terms below.
Confirm agreement by selecting both
Terms of Agreement
Check to agree with terms
Signature
Should be Empty:

Booking Agreement