Dr. Brandynicole Booking Request Form

IFORMATION/BOOKING REQUEST FORM

Thank you for your interest in Dr. Brandynicole, LLC! Dr. Brandynicole will use the skills of engagement, empowerment and education to get your audience excited about the work ahead. Please complete this booking request form and a member of her team will be in touch within 24-72 business hours.
POINT OF CONTACT (POC) INFORMATION
Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Best Mode of Contact*

SESSION INFORMATION
Which are you requesting of Dr. Brandynicole?*
Do you have a speaking/training topic in mind? If so, please share more below.*
If other, please describe.
How long would like you Dr. Brandynicole to present/participate?*
Will Dr. Brandynicole's session be recorded?*
How did you hear about Dr. Brandynicole?*

WebsiteYoutubeWord of MouthSocial MediaOther
What additional information would you like Dr. Brandynicole to know about your event, your participants, or her session?
I consent to Dr. Brandynicole marketing her participation on social media platforms. *

Thank you again for your interest in working with Dr. Brandynicole, LLC. As stated, we will be in touch within 24-72 business hours.
Please verify that you are not a robot.*
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IFORMATION/BOOKING REQUEST FORM