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.
Email address *
Name and Title of Person of Contact *
Email address *
Phone *
Name Organization
Organization Website
Organization's status
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Event date *
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DD
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YYYY
Event location *
Event Website
Event name and theme
Expected number of attendees / participants *
Is the event free for attendees *
If the event is not free for attendees how much is registration/admission for each attendee? *
Other speakers / invited guests:
Event sponsor(s): *
Type of presentation requested:
Clear selection
Budget for requested speaker / presentation:
Other special requests (check all that apply):
What do you want attendees to get out of your event?
Can contact forms or info sheets be given to attendees?
Clear selection
Can products be sold at this event?
Clear selection
Additional comments / info about Event: (Target audience/focus)
Any supporting documents/ files pertaining to request
A copy of your responses will be emailed to the address you provided.
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