REQUEST CYNTHIA FOR YOUR EVENT
Complete the form below if you would like more information about hosting Cynthia at your event.
Enter Your Name
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First Name
Last Name
Enter Your Email
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Best Phone Number
*
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Area Code
Phone Number
Organization/School Name
*
Your Title
Type of Event
In-Person Event
Virtual Online Event
Event Location
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Date of Your Event
*
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Month
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Day
Year
Date
Location Address
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Will you charge a fee for attendees?
Yes
No
*If this doesn't apply, please skip.
What is your speaker budget?
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Yes
No
Unknown
*Cynthia charges a fee, but is willing to negotiate. If your budget is unknown, please choose Unknown.
How many are expected to attend your event, or how many grade levels and/or students are expected?
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*For schools, if multiple grade levels are expected, please indicate the grades and how many are expected per grade.
What is your event topic, goal of the event or what would you like Cynthia to speak about?
*
*Cynthia is gifted and well-versed with a variety of Empowerment Talks. If you'd like a specific topic to be addressed, please specify.
REQUEST CYNTHIA
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