Podcast/Radio Guest & Speaker Request Form

Podcast/Radio Guest & Speaker Request Form

Dr. Thompson is a best-selling author and sought after guest. Submit your request here and expect a response in 3-5 business days. Questions? email info@doctormoniquethompson.com
Contact Information
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Organization Website*
Job Title Of Primary Contact*
Please share additional information about the convening organization (e.g. sector, mission/purpose, etc.)*
Topic and Event Information
Type of Event*
For example: Live, Recording, Virtual, In-Person, Conference, Panel
Topic of the presentation*
For example: Relationships, Mental Health, Education, Faith-Based, Parenting, Couples
Expertise Requested*
Examples: General Mental Health, Infidelity, Zero Debt College Project, Faith Based Mental Health, Workplace Wellness, Couples, Youth, Family, Generational Trauma
Confirm Type of Event*

VirtualIn-PersonHybrid
Event Format (select all that apply)*

Panel DiscussionKeynote SpeakerFormal PresentationClosed-Door BriefingRoundtable DiscussionQ & ARetreatOther
Please share additional details about the format.*
Date and time of the event*

MonthDayYear
Date
Duration of the presentation and the event*
For example, is Dr. Thompson needed for the full event, for a workshop of two hours, to give a keynote, or to be present for a specific portion
If you have additional details about the event moderator and additional participants, please share them.*
For example, will participants be "LIVE" meaning virtual face-to-face with Dr. Thompson or will they be in a webinar format, or in an audience.
Event audiences (select all that apply)*

AcademicsJournalistsPolicymakersPublicStudentsTopic ExpertsOther
Please provide more details*
Do you expect members of the media to attend the event?*

YesNoUnsure
By when will you need a response?*

MonthDayYear
Date
Will an honorarium be offered? (Please note: There are no pro-bono in-person events, select pro-bono virtual opportunities will be considered in 2026, there are no pro-bono virtual or in-person opportunities available for 2025). Non-profits are encouraged to seek a corporate sponsor or donations to cover their honorarium.*

yesno
Share anything else that might help with considering your request.*
For instance, has Dr. Thompson worked with your organization in the past, do you have a pre-existing professional or personal relationship with Dr. Thompson, is there anything else we should know to consider your request?
Should be Empty:

Podcast/Radio Guest & Speaker Request Form

Contact Information

Topic and Event Information