Book Dr. Misty to Speak
First Name
Last Name
Email
*
Phone
*
Name of Event
Date & Tine of Event
Address/Location
Type of Event (Brunch, Worksahop, Conference, ect)
The event will be
In-Person
Virtual
Expected Number of Attendees
Please list any event sponsors
Media (Will media be invited? If so, please provide the media list)
Cost of Attendance (Please include member and non-member price, if applicable)
What is your speaker budget? (Include exact $ amount or range)
How would you like Misty to contribute to your event?
Keynote Speaker
Workshop Facilitator
Trainer
Panelist
Host/MC
Other
How long will you need Misty to speak?
Presentation/Speech Topic Preferred?
Will this speech be followed by a Q&A session?
Yes
No
Will Misty be allowed to promote any of her products/services?
Yes
No
Let's Discess it!
Will travel accommodations be needed? (Please keep in mind Misty is located in North Carolina))
Yes
No
N/A
Deadline for Acceptance (Please provide an exact date)
Any additional information you would like for Misty to know or consider?
Submit
