Training or Workshop Request Form

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Please complete the following form if you would like to request a workshop, training, or lecture for your organization or business.
To ensure I have energy and spirit to care for myself, my family, and my clients, please allow 2-3 business days for an initial response. (Mon-Fri except major holidays.) Requests will be considered in the order they are received. I am currently only available virtually although that may change in the coming months.

I thank you for your interest and your time.

Requesting Organization, Business, or Group *

Contact Person's Name (First, Last) *

Contact Person's Phone Number

Contact Person's Email *

My organization is most like... *

an public agency or non-profit agency providing mental health or other health services

private practice or group private practice

small business or LLC

a private business or corporation

education or related setting

faith-based organization or non-profit community group

Other:

How soon are you hoping to collaborate? *

Within the next month

Within the next quarter

This calendar year (through December 2022)

Next calendar year or beyond (January 2023 and onwards)

We have options or choices (i.e. standing training dates/schedules)

Not sure, we're still planning

No rush, just want to collaborate!

Other:

What format best fits your current agenda and plans?

Lecture

Interactive Workshop

Educational Presentation

Roundtable or Discussion

Other:

Clear selection

Please provide a description of the audience and who will be participating.

In short, what areas are you seeking information on?

Special Instructions or Notes

Submit

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