Speaker Request Form
Book Basiliso (Bas) Moreno, LMSW. Please fill out the form below to book me for any speaking opportunities. Thank you in advance.
Name
First Name
Last Name
Email
example@example.com
What is the name of your organization?
Is it a For Profit or Non-Profit organization?
Is the event:
In Person?
Virtual?
What is your speaker budget?
How long would you need Basiliso to speak for?
Will Basiliso be able to promote any of his products or services?
Yes
No
Let's discuss further
Will travel accomodations be offered or needed?
How did you hear about Basiliso (Bas) Moreno, LMSW?
Submit
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