Book Dr. Kathy

Please complete the form below as we work to build a contract for your event

Hosts Name

First Name

Last Name

Sponsor Email

Sponsor Phone

(###)

###

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Sponsoring Organization

Date(s) of Event

Event Location

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Speaker

Proposed Honorarium Amount

Note that Dr. Kathy's current speaking rate is $8500/day

Travel Stipend

Note that Dr. Kathy typically requires travel, lodging, and meals for two people, approximately $1500 per event

Event Details

Event Name

Event Theme

Approximate Audience Size

General Audience Description

Venue

Event Itinerary