Speaking Inquiry Form for Ami Kunimura, Ph.D., MT-BC
Founder of The Self-Care Institute
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Your contact information:
Your name:
Your email address:
Your phone number:
Name of your company, organization, and/or event (if applicable)
Size of your company, organization, and/or event (if applicable)
 Location (also please indicate virtual or in-person preferences):
Event date and time (if known):
Who will be in the audience? Who will this event be for?
Type of speaking event you are interested in (check all that apply)
What topics are you interested in? (Check all that apply)
What is your budget for this event?
Please describe more details of what you are looking for and how you hope Ami Kunimura's expertise can be of help to you, your organization, or your event. Feel free to share anything else we should know about you and/or your organization.
How did you hear about us?
Availability varies by month and rates vary by event type, size, length, and, location.
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