Contact & Booking Request Form
Re: Bernadette Myers Services
Full Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Email
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example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What service(s) are you interested in?
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Please Select
Womens Empowerment
Growth Mentorship
Speaking Engagements
What is your honorarium budget?
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What is your website link?
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When and where is the event if? If applicable (type N/A if not applicable).
*
What is your Instagram/Facebook handle?
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How many attendees are you anticipating? If applicable (type N/A if not applicable).
*
How long will the segment be and what topic would you like Bernadette to cover? If applicable (type N/A if not applicable).
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Message
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A NON-REFUNDABLE deposit is required to secure the date. Type AGREE if you AGREE. If applicable (type N/A if not applicable).
*
Terms & Conditions are provided in email confirmation. Upon securing booking you must agree to Terms & Conditions. Type AGREE if you AGREE. If applicable (type N/A if not applicable).
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Please Print Your First and Last Name to confirm submission.
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Date
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Month
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Day
Year
Date
SUBMIT YOUR REQUEST
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