Dr. Sylvia Gonsahn-Bollie Speaker Inquiry Form

Dr. Sylvia Gonsahn-Bollie Speaker Inquiry Form

Interested in having Dr. Bollie speak at your event? Share a few details about your event & we'll contact you! Please note that not every question applies to every situation. Please fill it out as best as possible with the questions that apply to your feature or speaking event.
NOTE: Please submit any speaker/guest appearance requests at least three weeks before your event or recording date.
Contact Name*

First NameLast Name
Organization Name*
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Role in Organization or Relationship to Event*
Please list each company or organization the speaking engagement is sponsored by or connected with.*

Event Details
Name of the Event or Show*
Event or Show Type*

PodcastSocial Media Live EventWorkshopFundraiserConferenceOther
Event or Show Details*
Event or Show Website
Event or Recording Date*

MonthDayYear
Date
Event or Recording Time*

Hour Minutes

AM/PM Option
Event Venue (list address if live; if virtual include log-in information)*
Is this a one-time or ongoing event?*

One-TimeOngoingOther
Anticipated Attendance or Viewership For This Event*
Other Audience Details (Background of attendees, age range)*

Event Details