Dr. Shanita Brown Speaker Inquiry Form

Dr. Shanita Brown Speaker Inquiry Form
Thank you for your interest in having Dr. Shanita Brown speak at your event. To help us facilitate your request, please complete and submit the following form. Please note that completing and submitting this form is not a "YES" to your request. This form is simply receiving information about your event. Once approved, you will receive an email with further booking information.
Let's Get Started!
Name *
Contact Person*

First NameLast Name
Phone Number*

Area CodePhone Number
Email Address*
example@example.com
Industry or Profession*
Event Date*

MonthDayYear
Date
Event Type*

VirtualIn-PersonOther( Please Specify)Other
Address( If in Person)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event Time*

:HourMinutesAM/PM Option
Event Type:(conference, training, small group, etc.):*
Length of event and length of service Dr. Brown is asked to do:*
Event Title/ Purpose/Goal:*
Please provide a website link with more information about your event*
Estimated number of attendees?*
Presentation Format*

Professional SpeakerMotivational SpeakerEmpowerment SpeakerKeynote SpeakerWorkshop FacilitatorEvent HostPanelistsPresentationsPreachingTeachingRadio/TV/Podcast Interview
Requested Topic*
Who's the audience?*
What do you want your audience to take away and really get out of this event? This helps me to customize my presentation for your event to meet your goals and objectives.
Is there anything else you wish to share with us about your event that you think we should know?
How did you hear about us?
Should be Empty: