Dr. Kalisha Bonds Johnson - Speaker Inquiry Form

Request a Workshop or Organizational Consult
Thanks for your interest in partnering with KBJ Collective. This short form helps me understand your goals, audience, and timeline so I can recommend the best next step. It takes about 2 minutes to complete. You’ll hear back within 3 business days with next steps and scheduling options.

Note: This form is for organizational requests only (not urgent medical concerns).
Section 1: Contact Information
Contact Person*

First NameLast Name
Organization / Institution:*
Website Address
Title / Role:*
Email Address*
example@example.com
Phone Number*
Section 2: Request Information
Event Name
Type of Request: (select one or multiple)*

WorkshopTraining/ Educational SessionCase Review RoundsReality CheckKeynote/ Panel DiscussionOther
Primary Audience: (select or describe)*

Employees/ Employee Resource GroupsHealthcare Professionals/ CliniciansFamily CaregiversCommunity GroupAcademic / Research CommunityPolicy or Organizational LeadersMixed AudienceOther
Expected Audience Size:*
Event Location / Platform: *
(city, state, or virtual)
Desired Date:*

MonthDayYear
Date
Desired Time

Hour Minutes

AM/PM Option
Biggest Challenge/ Goal*
Budget Range (optional but helpful):
How did you hear about Dr. Bonds Johnson?*
Thank you — you’re all set.
We’ll review your request and reply within 3 business days with next steps and scheduling options. If you have anything time-sensitive to add, email collective@drkalisha.com
with your organization name in the subject line.
Please verify that you are human*
Thank you for your inquiry!
Should be Empty:

Request a Workshop or Organizational Consult

Thank you for your inquiry!