Speaking Inquiry Form
If you are interested in having Dr. Cherita speak at your event, please complete the form below. We'll be in touch shortly after reviewing it. Thank you.
Email address *
First Name *
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Last Name *
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Are you the decisionmaker? *
Organization *
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Organization Type *
Organization's Website *
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Phone Number *
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Best Time to Contact *
Name of Event *
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Event Date *
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Event Theme *
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Type of Event *
Type of Presentation Requested *
Audience (select all that apply) *
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Age Range (select all that apply) *
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Anticipated Audience Size *
Speaker Budget *
Will there be other speakers? *
Are you charging admission? *
Will Cherita be able to promote her products/services? *
Do you plan to purchase copies of Dr. Cherita's book, Go! 10 Powerful Steps to Accomplishing Your Goals & Living the Life You Desire? *
How did you hear about Cherita?
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A copy of your responses will be emailed to the address you provided.
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