Booking Request Form

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Full Name* This field is required.
First Name
Last Name
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Email Address* This field is required.
example@example.com
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Phone Number
Please enter a valid phone number.
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Organization Name* This field is required.
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Event Name * This field is required.
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Date and Time* This field is required.
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Minutes
PM
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Event Location (venue or virtual platform)* This field is required.
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Type of Event (conference, workshop, panel, professional development session, etc.)* This field is required.
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Audience Type & Number (students, educators, staff, etc.)* This field is required.
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Requested Topic of Area of Focus * This field is required.
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Is there a speaker/workshop budget for this engagement?* This field is required.
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Will travel, lodging, or mileage be covered if the event is in person?* This field is required.
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Are there specific challenges, themes, or institutional goals Dr. Smith should know about?* This field is required.
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Additional Details or Special Requests* This field is required.
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Thank you for your interest in booking Dr. Taiesha Smith for your event or workshop. Your request has been received. Please allow 2–3 business days for review. If the engagement appears to be a good fit, you will be contacted to discuss availability, session goals, pricing, and next steps.
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