Dr. Kalisha Bonds Johnson

Dr. Kalisha Bonds Johnson

"The Woman and The World Changer"
Are You Ready to Leave Your Audience Empowered, Inspired, and Ignited?!
Speaking Engagement & Training Request Form
Thank you for your interest in inviting me to speak or provide training. My goal is to make every engagement meaningful, evidence-informed, and deeply human.

Whether you’re planning a keynote, workshop, or professional development session, I strive to create spaces where participants feel both informed and inspired — bringing calm, confidence, and compassion to dementia care.

Please take a few moments to share more about your event so we can explore how I might best support your goals and audience.
Section 1: Contact Information
Contact Person

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

ConferenceWorkshopKeynotePanel DiscussionTraining / Educational SessionOther
Event Description:
Briefly describe the purpose or theme of the event.
Event Date(s):

MonthDayYear
Date
Event Location / Platform:
(city, state, or virtual)
Event Time

Hour Minutes

AM/PM Option
Expected Audience Size:
Primary Audience: (select or describe)

Family CaregiversHealthcare ProfessionalsAcademic / Research CommunityPolicy or Organizational LeadersMixed AudienceOther (please specify)Other
Section 3: Presentation or Training Goals

Purpose: Clarify the intent and desired outcomes.

This section helps me tailor the content to your group’s unique needs.
What would you like participants to walk away with?
What specific challenges or opportunities around dementia care would you like addressed?
Are there key themes, outcomes, or objectives already defined for this event?
Section 4: Format & Logistics

Purpose: Capture practical details and expectations.
Requested Duration:

30 minutes45 minutes60 minutesHalf-day workshopFull-day trainingOther (please specify)Other
Preferred Format:

In-personVirtual (Zoom, Teams, etc.)Hybrid
Will this session be recorded or distributed afterward?

YesNoUnsure
Technology or A/V Support Provided:
Section 5: Budget & Next Steps

Purpose: Create transparency around fees and follow-up.
Honorarium / Speaker Budget:
Are you requesting a customized presentation or existing topic?

Custom contentExisting talk or training
Ideal date for a follow-up conversation:

MonthDayYear
Date
Additional Notes or Questions:
Section 6: Optional Background

Purpose: Gives you insight into who’s reaching out, while reinforcing your mission.

This section is optional, but helps me understand how your organization connects with dementia care or caregiving support.
How does your organization currently engage with dementia care or caregiver support?
How did you hear about Dr. Bonds Johnson?
Thank you for reaching out and for the important work you do. I look forward to learning more about your event and discovering how we can collaborate to advance compassionate, culturally responsive, and evidence-based dementia care.

You’ll receive a confirmation once your request is submitted, and I’ll follow up soon to discuss details.

Warm regards,
Dr. Bonds Johnson
Helping you care for others without losing yourself.
Please verify that you are human*
Thank you for your inquiry!
STAY CONNECTED. FOLLOW DR. KALISHA BONDS JOHNSON TODAY!
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Are You Ready to Leave Your Audience Empowered, Inspired, and Ignited?!

Speaking Engagement & Training Request Form

Thank you for your inquiry!