Speaker/ Trainer/ Consultation Request
Thank you for your interest in having Shivonne Odom speak, train, or consult. Please complete the form below so that we can address your professional needs. All professional phone calls/ virtual meetings to "run ideas, ask professional questions about career, private practice, maternal mental health counseling, discuss professional goals, books, products, and collaboration" or "pick your brain" are a flat consultation fee of $140 per hour for all interactions 15 minutes-one hour in duration. This form must be completed in addition to any emails sent prior to completing this form so that we can respond to your request.
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Email address
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Your email
Name and Title of Person of Contact
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Your answer
Email address
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Your answer
Phone
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Your answer
Name Organization
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Organization Website
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Organization's status
For Profit
Non-Profit/ 501 (c)(3)
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Event date
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Event location
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Event Website
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Event name and theme
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Expected number of attendees / participants
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Your answer
Is the event free for attendees
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Yes
No
If the event is not free for attendees how much is registration/admission for each attendee?
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Other speakers / invited guests:
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Event sponsor(s):
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Type of presentation requested:
Timed Talk (list time under additional info)
Keynote Address
Event or Panel Moderator
Panel Discussion
Workshop/ training
Other:
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Budget for requested speaker / presentation:
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Other special requests (check all that apply):
Meet and Greet
Speaker Attendance at Breakfast, Lunch, Dinner or Reception
Photo / Video permission
Media Interviews
Other
What do you want attendees to get out of your event?
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Can contact forms or info sheets be given to attendees?
Yes
No
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Can products be sold at this event?
Yes
No
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Additional comments / info about Event: (Target audience/focus)
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Any supporting documents/ files pertaining to request
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A copy of your responses will be emailed to the address you provided.
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