Name *

Please include the contact information for the person that is able to sign contracts on the company's behalf (even if it is not the point of contact for the event).

First Name

Last Name

Contact Phone Number *

This is the number needed to contact your team regarding travel and event logistics. Please include a phone number and do NOT write N/A

Country

(###)

###

####

Company/ Organization Address *

Not Event Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Event Point Of Contact Name

Please only complete the following section if the point of contact for the event is different than the person who's signing contracts for the event.

First Name

Last Name

Event Of Contact Phone Number

(###)

###

####

Is the organization a 501 (c)(3) Non-Profit? *

Yes

No

Event Date(s) *

MM

DD

YYYY

Specific Date for Natasha's Session *

Please list the exact date and time you'd like to request to have Natasha speak during the event

MM

DD

YYYY

Specific Time for Natasha's Session *

Hour

Minute

Second

AM PM

Location of the Event (Address included, if available)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is this event in person or virtual? *

In-person

Virtual

How do you want Natasha involved? *

Keynote

Workshop/Training

Panel

Moderator/ Host

Other

Speaker's Topic *

Choose the signature topic for your event or select "other" if you are requesting a customized topic

Personal brand identity (executing goals and purpose)

Confident mindset (overcoming fear and doubt)

Mental Self-Care (burnout recovery/ life balance))

Trauma- Informed & Culturally Responsive Leadership (for schools & businesses)

Other