Consulting/Speaking/Workshops Request Form
Thank you for considering Dr. Mishelle Rodriguez and the Collaborative ChangeMakers team!
Let's start the conversation. Please complete the form below and our team will get back to you shortly with the next steps.

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Name *
Company/Organization Name *
Contact Email *
Contact Phone Number *
Please provide a link to your website
What type of service are your interested in? *
Required
Event's Title and Type of Event
Describe the event/workshop/consultation services you're interested in *
Theme/Purpose of Event
Event Date(s)
Event Time(s)
Event Location
How many attendees do you expect for your event?
Who will the audience consist of? (e.g., demographics, roles in organization)
What is your budget?
Is your event sponsored? If so, please provide details
Is there anything else you about your event or organization that you think we should know?
How did you hear about Dr. Mishelle and/or Collaborative ChangeMakers?
Thank you for filling out this speaking event/consultation/workshop questionnaire. We will review your information and get in contact with you soon!
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