Request Form: Work w/Miriam Plotinsky
Thank you for reaching out! This form will help me get a sense of logistics and what you are looking for so I can assess whether it's a fit with my skills and capacity. After I receive your information, I will follow up via email.
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Your Name *
Email address  *
Phone number  *
School, District or Organization  *
Your Role  *
How did you hear about me? 
Tell me a little bit about your school or organization.
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What type of service are you seeking? (Professional development workshop or series? Keynote? Consulting? Something else?)
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Topic  *
Estimated number of attendees  *
Ideal dates and times for workshop/session
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Length of workshop/session desired
 *
I offer both in-person and online PD based on logistical considerations like time and distance. Which is your preference?
 *
Budget or budget range for this work?
 *
Anything else you'd like me to know?
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