WWTTMAD & TOI Request Form
               

To hire Cassandra for your next event, please complete the form below in its entirety and click on the Request Cassandra Burckhalter button at the bottom of the form. A representative will contact you within 3 business days.


Your Contact Information

Requestor’s Name

     

Title

Company

Street Address

City

State

Zip Code

Phone Number

FAX

Email

 

About Your Conference/Event

What are your needs? MC, Speaker (Keynote, Workshop, Panel), or Facilitator

Conference/Event Theme

Conference/Event Location

Conference/Event Date, Start & End time

Who will comprise the audience?

Anticipated number of Conference/Event attendees

Will the event be recorded (video or audio)?

Anticipated number of media attendees

Budget allocated

Deadline date for our response to participate in your event

 
 
 
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