Your Name/Contact Person * First Name Last Name Email * Organization/Company * Phone * (###) ### #### Type of Organization * For profit Non profit Name of Event * Date and time of event * Location of the event * (In-person- provide address or virtual) Expected number of attendees * What is your speaker budget? (Include exact $ amount or range) * How would you like for DeShelle to contribute to your event? * Keynote Speaker Workshop Facilitator Panelist Other How long will you need DeShelle to speak? * Presentation/Speak Topic Preferred * (Prenatal/Postnatal Support, Trauma and Intimate Relationships, Women's Wellness, etc.) Will this speech be followed by a Q&A session? * Will DeShelle be allowed to promote any products/services? * Will travel accommodations be needed? Please keep in mind DeShelle is located in the Greater-Atlanta area. * Deadline for acceptance (please provide exact date) * How did you hear about DeShelle? * Any additional information you would like for DeShelle to know or consider? * Thank you! Please take the time to fill out the information below so that I can access your needs for your next event